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Final Waiver of Lien <br />State of Indiana, County of St. Jose SS: <br />Dustin Hilary being duly sworn that he/she Is the South Bend Area Vice President <br />(Name of Officer) (Title) <br />of mm Walsh & Kelly Inc. rn having contracted with mm City of South Bend, Indiana <br />(Contractor) (Owner) <br />to famish certain materials and/or labor as follows- oqc te and StripAiq <br />Asphalt Pavin <br />(Description) <br />for a project known as 2019 Comrwni!y m�r D4 <br />(Name of Project) <br />located at Corby, Jefferson, Linden and Riverside throughout the City of out Bend <br />and owned by _qty of poi Lt!,j..pfrid, Indiana <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 />❑ 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 Waiver 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 kom the contractor Is the sum of <br />. . . . ............. __ ------- ____ ........... . ..... <br />E] 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 Waiver of Lien which shall <br />become effective only upon receipt of such payment. <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 as account of labor or material or both, ftimished b the undersigned <br />(hereto, subject to limitations or conditions mpres ;and further certified Ilia" (leer party, , any claim orright to a <br />lien on account of any work performed or mate veraigned for said prKJicct and w119 io scope of this Affidavit <br />and Waiver of Lien >Y <br />Walsh & Kelly Inc POR,4 <br />----------- <br />(Authorized Represcatative) <br />STATE OF INDIANA n Hilary, South Bend Area Vice President <br />SEAL <br />SS: <br />% ..... . .... <br />ST. JOSEPH COUNTY 00 <br />Before me, the undersigned, a Notary I I I D*0(0 -ounty and State, personally appeared Dustin Hilar <br />A� IMMI ttoalver of Lion. <br />%pool' <br />and acknowledged the execution of the foregoing <br />IN WITNE'SS WITEREOF, I have 1wrounto subscribed my name and affixed my of I on the 1 8th day of <br />Decernber 200 19 <br />�ohtry ublic, Signature <br />My Commission Expires: June 07, 2023 <br />Ate Elizabeth furinu Staff Accountant <br />Residing to .,Marshiall County, _1pd1ana-_-__ <br />44 fURMN <br />te of 46aoa <br />Saar;* ?, 2023 <br />