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Hug. 1. zuvo J:47rm bKu rub WUKKS & SAFLIY No.5666 P. 2 <br />AFFIDAVIT AND 'WANER OF LIEN <br />State of Indiana, County of S t . Joseph' SS; <br />Donald Ritschard Jr. being duly sworn that he/she is the Vice President <br />(Name ofOfficer) (Title) <br />of Ritschard Bros., Inc. having contracted with City of South Bend <br />(Subcon for/Supplier) (Contractor) <br />to furnish certain materials and/or labor as follows: Demolition <br />(Description) <br />for a project known as olitions Phase 2 -Division A <br />(Name of Project) <br />located at Various Addresses <br />and owned bySouth Bend <br />) <br />. (Owner <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL. WAIVER) that there is due from the Contractor thesum of <br />ne Hundred One Thousand. Four Hundred <br />Twenty—two and 0 100 Dollars <br />($101 '.00 <br />❑ receipt of which is hereby acknowledged; or <br />® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given <br />solely with respeet to said amount, and which waiver shall be effective only upon. receipt Of payment thereof by the <br />undersigned; <br />924AL W It) that the final balance due from the coniractoar is .the sum of <br />($ 1 <br />❑ receipt of which is hereby acknowledged; or <br />El the paymont of which has been promised ,as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become eff"ectivo only upon receipt of such payment. <br />TBEREFORA' <br />the undersigned waives and releases unto the Owner of said premises, .any d liens or claims whatsoever <br />on the above -described property and improvements thereon, an account of o or vial or bo shed b the undersigned <br />theretca, subject to limitations or conditions expressed herein, if any; and er r has any claim or right to a <br />lien on account of any work performed or material f%nished to the un igned r s d p j cope of this Affidavit <br />and Waiver ofLien. <br />Ritschard. Bros., Inc. � ��" <br />(Firm) a �Ut4orUressentetive) <br />STATE OF INDIANA ) <br />SS: <br />ST.J'OSEPHCOUNTY ) <br />Before me, the undersigned, a Notary Public, iaa said State, personally appeared Ritschard, Jr. <br />and acknowledged the execution of the foregoing Affidai+it and d o 1 a. <br />IN WITNESS WHEREOF, I have. hereunto sul"ed y tlWaed ff icial seal on the 13 th day of <br />e'hrruar r 20 <br />N Rnblic Si <br />wA d"tAAA <br />tart' �e <br />M CommissionE fires: ��'�.,." o <br />Y Expires: 2224 r w� <br />a i i is Rachelle L. Dolniak <br />Residing in St. Joseph County, Indiana Notari,Publi'cName <br />