Laserfiche WebLink
Final Waiver of Lien <br />State oflndiana, County of T ` SS: <br />/ being duly sworn that he/she is the <br />(Name of Offlcer) _ (Title) <br />of ► having contracted with City of South Bend <br />(Contractor)fij� (Owner)to furnish certain, materials and/or labor as follows: � � � 614 J <br />for a project known as (blame%0F,0,,J�Dx-4-/1J—r3 <br />located at <br />and owned by _City of South Bend <br />(Owner) <br />and does hereby further state on the behalf of the aforemtentioned subcont motor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />.... , Dollars <br />❑' receipt of which is hereby acknowledged; or <br />El Mire payment of which has been promised as the sole consideration for this Affidavit and Final Wafer ofLlan which is given <br />solely with respect to said amount, and which waiver sball be effective only upon receipt of payment thereofby the <br />undersigned; <br />h �) that t' ce due from the COrtrtfptor is the sum of <br />r l"�Ilw1AL WAIVER) that the final balance � � �. <br />/ <br />❑ receipt of which is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner ofsaid prernlses, any and all liens or claims whatsoever <br />on the above -described property mid improvements thereon, au account of labor or material or both,, iitrnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and fr dbrx certified that no other party has any claim or right to n <br />lien, on account of any work performed or material flimislted to the rtdersigned for said ro'ect, and within the scope of this Affidavit <br />and Waiver of Lien. <br />STATE OF BY <br />urn <br />INDIANA ) ) A(Autr�xad Rep,rescartatiws) <br />SS: Mark Manninen/Branch Mgr <br />ST, JOSEPH COUNTY ) Shambaugh 8 Son, L.P. <br />Before me, the undersigned, a Notary Public, in and for said Countyand State aaw it care <br />, p p .... rJt?� <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN Wl NE SS WHEREOF, I have hereunto subscribed my name and affixed my o is the day of <br />Notary � c S aturre <br />Corey A Bames <br />Note Public Seal State of Indiana Publi ge e <br />n' Joseph County <br />My Commission Expires: a� Commission Expires <br />09/20/2020 <br />Restdin in r. <br />N Ptrlrllo <br />8 County, __._ �r�' Notary Home <br />