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Final Waiver of Lien <br />State of Indiana, County of SS: <br />being duty sworn that he/she is the <br />e"'v \�' . _L" � L I _r � � _31LL1 7 <br />(Name of9fficer) (Title) <br />of having contracted with City of South Bend <br />{Contractor) (owner) <br />to furnish certain materials and/or labor as follows-, <br />posorlption.) <br />for a project known as L <br />located at <br />and owned by City of South Bend <br />(owner) <br />and does hereby further state on the behalf of the aforementioned sub contractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars _J$ <br />E3 receipt of which is hereby acknowledged; or <br />E] the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien -which is given <br />0 receipt thereof solely with respect to said amount, and which waiver shall be effectiveo ly upon r c ipt of payment r of by the <br />undersigned; <br />(FINAL WAIV that the final balance cl�e from ffi of `7 111 <br />lontractor 4 <br />vu, / <br />E] 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 shall <br />become effective ouly 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 undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Llem <br />By <br />r" (Firm) (A—utorized /esentative) <br />STATE OF INDIANA <br />SS: <br />ST. JOSEPH COUNTY <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed tZ name and affixed my official seal on the <br />a.t2() <br />—NottityPubliq Sigr <br />My Commission Expires', .111") ' Z' " L I ___' <br />' �':� County) ROBYN <br />Residing in 'LaT��UBLIC - S <br />COUNTY OF MA":"')MD <br />My Commission Exrlws Auga.-A �, 2026 <br />Acting in the County of <br />k' I <br />N! day of <br />