Laserfiche WebLink
Final Waiver of Lien <br />Stal fIndiana, County of ., "' �SS: <br />� <br />-- <br />. being duly sworn that he/she is the <br />arn Of Omer) _ (Title) <br />of% having contracted with r <br />(fontractor) _ (Owner) <br />to famish certain materials and/or labor as follows: w �� " <br />i^oft 1, AL <br />for a project /mown as , , �,, �i.� ' �: i <br />located at <br />and owned by <br />X <br />(Name <br />and does hereby further state on the behalf of the aforementioned subcontracWsupplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars, <br />❑ receipt of which is hereby aelntowledgedd; 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 amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVED that the final balance due kom the contractor is the sum of <br />(S ) <br />❑ receipt ofwhieh is hereby aftowledged; 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 />TMEFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above-doscribed property and improvements thereon an account of labor or material or both, fbmished b the undersigned <br />thereto, subject to linrltations or conditions expressed herein, if any; and further certifled that no other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned fo ;sj project, and within the scope of this Affidavit <br />and Waiver ofLien. <br />- A444 <br />(Au�tborizel Representative) <br />�TATE OFµ NA^ L d ) <br />Cw�Ji � ) SS: <br />s1 *Ilf �t" MTY ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appearedITm t M °t c JCS <br />and aelmowledged the execution ofthe foregoing Affidavit and Waiver of Lien. <br />IN WITNESS VMMEREOF, I have hereunto subscribed my naino and affixed my official seal on the 5 day of <br />Frank Sc blie -y <br />:Notary Public, Stag signature <br />My Commission Expires: T7 My Commission Expires <br />0 w, July 20, 2020 i ^ <br />Residing in ' unty, r s w Notary Public fame <br />