Laserfiche WebLink
Final Waiver of Lien <br />State ofhAana, County of --MaLShaLL-- SS: <br />tt -X�irk )a trick L_ being duly sworn that he/she is the President <br />(Name of Officer)- (Title) <br />Of having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows-, Renovate 11 VPA Park Restroom Facilities <br />......... . . <br />(Description) <br />for a project known as <br />located at <br />and owned by <br />VPA Restroom Remodeling <br />(Name of Project) <br />.-S-QjLth. Bend IN <br />QiLLoLf South Bend <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />D receipt of which is hereby acknowledged; or <br />El the payment of which has been promised as the sole consideration for this Affidavit and Final "Via alver of Lien which is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />0,320.53 <br />El receipt ofwhich is hereby acknowledged; or <br />XEI the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become efreadve only upon re celpi of such paymant. <br />THEREFORE, the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor of material or both, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />lion on account of any work performed or material furnished to the undersigned for said project, and wlthl the scope of this Affidavit <br />and Waiver of'Llen. <br />By <br />(Firm) Author] d suntativa) <br />STATE OF INDIANA <br />Marshiill SS: <br />X"AX,)U&- hCOUNTY <br />Deforame, the undersigned, a Notary Public, hi and for said County and State, personally ppeared Andrea Fisher <br />and aoIcnowledged the execution of the foregoing Affidavit and Waiver of Lim, . . . . ..... <br />IN ATrNESS WHEREOF, I have hereunto subscribed name and affixed iriyofffic on y of <br />Nox�-- X19 2019, 1 <br />P blic Signature <br />My Commission Expires: March 27. 2022 <br />Andrea . hor e — ?A I <br />Residingin County, F3, I , 4 <br />9MVIEA JAE FISHER <br />Notary Public - Seal <br />State of Indiana <br />Marshall County <br />My Commission Ex$)ires Mar 27, 2022 <br />