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Final Waiver of Lien <br />State of Indiana, County of SS; <br />LJ�S�(/Q J �t �✓n� being duly sworn that he/she is the I� M <br />(Name of Officer) (Titlo) <br />of/el. l/tWcgntractedwith C" <br />(Contractor) ( wrier) <br />to furnish certain materials and/or labor as follows: ?OC V <br />(Description) <br />for a project known as <br />0201 <br />(Name ofProject / <br />located at U &end / A/ � f", La c4_/* ins <br />and owned by <br />(Owner) CIRAl <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier:[::aE <br />tate of Indiana County(PARTIAL WAIVER) that there is due from the Contractor the sum of ires Oct 22, 2022 <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 Walver of Lienwhich 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 />❑ xe�cet t o lochs he �b aokn v� � K •�`7 L."" <br />p y le ge � ox <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 />THEREFORE, the undersigned waives and releases onto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an acccunt of labor or material or both, liirnishetl b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party ha,s any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for saidproject, thin the scope of this Affidavit <br />and hlver of Llen. <br />ABy- Ca.1 <br />STATE OF DWIANA ir) <br />SS; <br />ST. JOSEPH COUNTY ) <br />Defore me, the undersigned, a Notary Public, in and for said County and State, personally appeared».Jon L iq . "�' <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. � <br />INW11 4SS WHEREOF, I have hereunto subscribed ray naive and affixed '�xed my official seal n the .., ay of <br />20 <br />NotaryPublic Signature <br />My Commission Expires: J D la ��a /D�' <br />Residing lr �_Jftkouftty'�. . 1�h:d <br />Nota Publ oNanie <br />