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State of Indiana, County of <br />Final Waiver of Lien <br />St. Jospeh <br />Gerald Longerot, <br />(Name of Officer) <br />Slatile Roofing and <br />of Sheet Metal CO.. INC. <br />(Contractor) <br />to furnish certain materials and/or labor as follows: <br />for a project known as <br />located at <br />SS: <br />being duly sworn that he/she is the President <br />(Title) <br />having contracted with City of South Bend <br />(Owner) <br />Masonry <br />(Description) <br />Vietnam Memorial <br />(Name of Project) <br />South Bend <br />and owned by City of South Bend <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 the sum of <br />Dollars _($ ) <br />01 receipt of which is hereby ael mowledged; 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 WAIVER) that the final balance due from the contractor is the sum of <br />Fourteen thousand one hundred forty two dollars and fifty cents <br />$14,142.50 <br />❑ receipt of which is hereby aclmowledged; or <br />El 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 unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon an account of labor or material or both, furnished b the u�qslgm�ii� <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has a i� i <br />lien on account of any work performed or material furnished to the undersigned for said project, and within. the Scb ego WIS A da4,, <br />and Waiver of Lien. <br />C11- d <br />Slatile Roofing and Sheet Metal CO., INC. ----'" : Z <br />(Auth riz rest CD <br />ve) <br />STATE OF INDIAN(Firm) <br />) <br />SS: ' <br />ST. JOSEPH COUNTY ) '?•,�� S TA T .. F C7<" <br />Before me, the undersigned, a Notary public, in and for said County and State, personally appeared <br />and aclaiowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITH SS WHEREOF, I have hereunto subscribed my name and affixed 7- <br />My Commission Expires: <br />Residing in ::rrIA U 0_r-%- .J County, <br />Public <br />STATE OF INDIANA <br />MY COMMISSION EXPIRES DECEMBER 18, 2027 <br />COMMISSION NUMBER NP0724157 <br />