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Final Waiver of Lien <br />State ofMana, County of t. Joseph SS: <br />Dustin HilaryArea Vice President <br />(Name ofOfficerbe duly sworn South Be....._.��.....,,,,..�� <br />� �► Bend <br />(Title) <br />Of Walsh & Kelly, Inc. having canttacteawith <br />City of South Bend <br />(Contractor) <br />(Owner) <br />p ._._ConcretemmmSidewalk Repair <br />tofixrnishcex�inmaterials and/or labor asfollows: Asphalt Parkin Lot(D�ndi Sidewalk <br />fora project known as 315 & 319 W. Jefferson Exterior Renovations (Division C) <br />.� <br />e (Name ofProject) <br />located at 315 & 319 W. Jefferson, South Bend <br />y Cit oµW�� ► � <br />_.,�. .__..uu <br />and owned b f South Bend <br />(Owner)C,©SA09 <br />• / i <br />qr •iZ= <br />and does hereby fuuther state on the behalf ofthe aforementioned subcontractor/supplier: <br />AL <br />(P ) there is due from the contractor the sum of % ,.' • �� <br />(PARTIAL WAIVER) that <br />..._...... ...�� ._ ,_A.. _� �Dollars <br />❑ receipt of which is hereby aclaxowledged; 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 hom the contractor is the sum of <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 shalt <br />become effective only upon receipt of such payment. <br />THMWORE, the undersigned waives and releases unto the OwAer 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, Rlrnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certlf'ied.tl no other party has any claim or right to a <br />lien on account of any work performed or material finished to the undersigned fob aak'i j <br />and Waiver of Lien ec AIwithin the scope of this Affidavit <br />Walsh & Kelly Inc.' <br />ff IM) .;"""'" Representative) <br />STATE OF 1NDIANA ) <br />) SS: <br />ST. JOSEPH COUNTY ) <br />and aal mowfore me, <br />tham undersigned,te Notaryforegoing uAffidavit and �...... <br />r said County and State, personally appeared ..-Dustin Hilary <br />d Waiver of Lien. <br />IN WITNESS WHEMOF, I al se on the $th.... day of <br />�t.�mberTM zno 20 <br />Y y <br />have hereunto subscribed m name and Red m official � � <br />No public Signature. <br />My Commission Expires: <br />Residing in __Marshall <br />June 7, 2023 <br />County, <br />pF �, AMID €LIZASE <br />Commissron Expires <br />June 7, 2023 <br />