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Final Waiver of Lien <br />State of Indiana, County of S t . ,dose h SS: <br />d 2,itschard. Jr.. being duly sworn that he/she is the Vice President <br />(Name of Officer) (Title) <br />of Ritschard Bros., Inc. having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Demolition <br />.. (Description) <br />for a project known as -ition phase. I - Pro- °"ect No. 119-035 <br />(Name of,Froject) <br />located at VariouG AddPesses <br />and owned by Cit of South Bend <br />(Owner) <br />and does hereby further state on the behalf ofthe 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 />❑ 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 aruowit, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVE that the final balance due from the contractor is the sum of <br />hire - c*.v'e a 22 100 5 33 .22 <br />❑ receipt ofwhioh is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this Affldavit and Final Waiver of Lien which shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives andreleases unto the Owner of said premise any Ly1has <br />claims whatsoever <br />on the above -described propertyand improvements thereon as account of ri or trtt e ' 0 ad undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and rrthc o a n o ory claim or rl0t to a <br />lien on account of any work performed or material firmished to the and signed r a p a d a of this Affidavit <br />and Waiver of Lien. <br />Rit har Bro . Inc. By\' \1/ <br />(Firm) (Authorized Representative) <br />STATE OF INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in end for said County and State, personally appeared Donald Rit;tisciasrd, Jr, <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed rm ffxr:lal seal on the �ddil4oiy <br />December 200 19 D 13, � <br />tuy <br />Ito <br />Slgnattr e r� <br />My Commission Expires: 2 2 �O TA R <br />Dgln <br />k. <br />Residing in S t . Jose. h County, Indiana 'l�lo Public Name `.. <br />{"�r,1 Wr <br />