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Final Waiver of Lien <br />State of Indiana, County of 1St jrvsQih -- SS: <br />Bill Favors being duly sworn that he/she is the <br />i.rit,g►� <br />(Name of Offlcer) (Title) <br />of , I 7,iolkow.ski �"r t strq� , �c �nc.. having contracted with City of South Bend <br />(Contractor) _ , <br />{Owner) <br />to famish certaln materials and/or labor as follows; Masonry repairs at the 315/319 Jefferson Buildii <br />(Description) <br />for aproject known as S �a t at to;_ ®C1 �t� va C' ro (Division <br />(Name of Projeot) <br />located at 315 & 319 West Jefferson <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 acln►owledged; or <br />❑ Il'to payment• of which has boon promised as tite sore ronskloratiou: for this Affida+vlt and Final Waiver o Lion which is given <br />solely with respect to said atnount, and which, waiver shall be efiective only upon receipt of payment thercofby the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />a t a,tl. i Screntv Six a nd 7' 1 t �� �.�.. ) 'sb,776 70 <br />❑ receipt of which is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this Affidavit andFinal Waiver of Lien which shall <br />become si%ctive only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above-deserrlbedproperty out] improvements thereon an account oflabor ormaterial or both, furnished b the undersigned <br />thereto, striaAect to limitations or Conditions expressed herein„ if aay mud further certlftad thatno other patty has any claim or right to a <br />lies► on account of any work per unod or material Amilshod to the undersigned for said project, and within the scope of this Affidavit <br />aid Waiver of'Llen. l <br />00 <br />7.iolko3M ' C n`triicti „ Irlc EY ' A dTt cn five) <br />STATE OF INDIA14A ) Bill 'Favors <br />S"I'. IOSi1t'II COUNTY } <br />S8.* President. & 0- <br />Before arse, tire imdcrslgeted, a Notary public, hr and for sold County And State, Personally appeared .•... B.i1i Fa�oxs <br />and acknowledged the e;recullon of the foregoing Affidavit and Waiver of Lion. <br />IN WrrNFSS WHEREOF, i have heretrnto subscribed nay natne and affixed nay official seat on fire l dth day of <br />Jan uary,._2020 �OOc w..•. <br />Notary I►arbl o S <br />My commission Expires: 6tb day of March, 2025 <br />Residing in Elkhart CountY, ._ In Notary public Name <br />LYNN DVINING <br />Seal <br />Notary Pubitc - S'tate of IndlIMI <br />t'tkhat't'Coullty <br />My Come missiOn Exgatres Mar 620 <br />