PCA - Lafayette Building Cleanout – Proj No. 119-098 - HomeWorks Construction, Inc.

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Final Waiver of Lien State of Indiana, County of St. Joseph SS: Jef re Smallwood being duly sworn that he/she is the Senior I rO"eCt ll�lana er r) (Name of office _ �. - ... (Title) of HomeWorks Construction, Inc. having contracted with City of South Bend (Contractor} (Owner) to furnish certain materials and/or labor as follows: Removal of loose debris (Descripdon) for a project known as Lafayette Building Clean -Out _ Proj #119-098 (Name ofProjaR) _._ located at 1150...., South Lafayette Blvd., South Bend, IN and owned by City of South Bend (Owner:) ....._._W and does hereby further state on the behalf of the aforementioned subcontractor/supplfer: (PARTIAL WAIVER) that there is due from the Contractor the sum of n. _.�.. Dollars-( ) ❑ receipt of which is hereby acknowledged; or ❑ tho payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only Capon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Six Thousand Four Hundred and Seventy Dollars and 13 cents $6,470.13 �- ❑ receipt of which is hereby acknowledged; or ® the payrrrent of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become offective only upon receipt of such payment. THMFORE, the undersigned wolves and releases unto the owner ofseld promises, any and all liens or claims whatsoever on the above -described property and improvements thereon as ACCOUAt oflabor or° tniterial or both, firrnlshed b the undersigned therato, subject to lirnitatlow or conditions expressed herein, if any; mud furthercertifted that no other party has any claim or right to a lien on account of any work performed or material lbruishad to the undersigned for said project; and within the scope of this Affidavit and Waiver ofLiem HomeWorks Construction, InC. (Firm)_ _ - (Au ori�e Ilapresentatave) STATE OF INDIANA ) ) SS: ST. JOSEPH COUNTY ) Before me, the undersigned, a Notary Public, In and for sold County and State, personally appeared�� l and acknowledged the execution of the foregoing .Affidavit and Waiver of Lien. ' m cla d affixed �7 day of V0 1N t�ESS WHEREOF, Ihave hereunto subscribed m 0� 0P)V. r onthe sea e y name and a Notary public Signature My Commission Expires: 111 g- 2o�'y Residing in 7 ( f„tx. County, .Lj!2AXM$E M LONG Notary Notary Public - Seal State of Indiana St Joseph County Commission Expires Sep 14„ 2022 Name ME