Laserfiche WebLink
State oflndione, County of <br />Final Waiver of Lien <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, <br />COMMISSION NO.710399 <br />E(KNA& SS: <br />/y� /J <br />1 ' A x Y �iik� being duly sworn That he/she is the �P, <br />(Name of Officer) (Title) <br />mlufh�huingcontractedwithof �City of South Bend <br />(Contractor) (Owner) <br />to famish certain materiels andlor labor as follows: <br />£or a project known es <br />located et <br />and owned by <br />�lAelouslaJc+��IoNsiFleDllc�Nou7 �l�C.(r� <br />of South Bend <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is duo from the Contractor the sum of <br />❑ receipt of which is hereby actotowledged; or <br />❑ die payment of which has been promised as the sole considemtlon for this Affidavit and Final Waiver of Lienwhich is given <br />solely with respect to said amount, and which weivcr shall bDo 0 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 />❑ receipt ofwhioh is herebyacknowledged; 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 only upon receipt of such payment. <br />THEREFORE, <br />the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above•descxlbedproparty and improvements thereon an account of labor• or material or both, fmnished 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 off Liem e�f� <br />Tum lu ff kc T� ' Si Vt �I.Y By ,!�/ <br />(Finn) (Authorized Representative) <br />STATE OF INDIANA ) <br />SS: <br />&3BSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared <br />end aelatowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, Ihavc hereunto subscribed my name and affixed my official seal on the � day of <br />y zoo sue_ �10 t m Qxokul <br />taty Pu61ic Signaturo <br />MyCanmissionEkpires: OoZIIaI x�� �� � ������ <br />Residing in RA County, 7AJDIJglk3A Notary Public Name <br />