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JANEEMTOWNER <br />NOTARY PUBLIC <br />SEAL <br />Final Waiver of Lien ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, <br />COMMISSION NO.710399 <br />State <br />eoofladian\a,'County of I C LKH Aa SS: <br />f ' 1 y )7 kcq - being duly sworn that he/she is the . <br />(Name of Officer) (Title) <br />of(n1Um ►�(� l E�_I�51�having contracted with UT l 0� JCU ICI obi r 1 i� <br />(Contractor) (Owner) <br />to famish certain materials and/or labor as follows; <br />for a project known as <br />4- <br />located at JAB\aI IS LOC AT(ON5 L&RA ( N1__ AE7 (3rV liF <br />and owned by <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <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 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 />F AL WAIV ) that tbg� 5nal balance due from the contractor the sum of�/ <br />uN I� Jl1( DU5�1lOFatt +klu1� I&EAZ M ($ <br />❑ receipt of which is hereby acknowledged; or <br />14 the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lien which shelf <br />become effective onlyuponreceipt 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 farther certifled that no other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. <br />�y— <br />f'Kfm l�m l/c f'lf�1U F 1 <X rz�j i;cc t Tg . By <br />(Firm) ' (Authorized Representative) <br />STATE OF INDIANA ) <br />ak Az-r ) SS: <br />fI 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 my name and affixed my official seal on the �q I r, day of <br />APT_ 201 4,C) M <br />mry Public Signature <br />My Commission Expires: 0A(- lcu(p <br />(`1 To(,JrJ�2 <br />Residing in U=K AA County, 10 of A�_ Notary Public Name <br />