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AFFIDAVIT AND WAIVER OF LIEN <br />©FINAL PARTIAL 0 PAYMENT TO FOLLOW <br />State Of Indiana, County of St. Jo <br />SS: <br />Gerald Lon erot being duly sworn states that he is the _- President <br />Slatile Roofing & Sheet Metal Co., Inc. <br />(Subcontractor/Supplier) <br />(Contractor) <br />Furnish certain materials and/or labor as follows: ��p nY' <br />For a project known as <br />. L-us'n2l V\-A di /7 At <br />located at: - rb, <br />and owed by L-4-4-4 Cq L5QtA1_ <br />(Owner) <br />and does hereby further state on behalf of the aforementioned subonctractors/supplier:. <br />PARTIAL Waiver that 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 considertion ofthis Affidavit and Partial <br />Waiver of Lien which is given solely with respect to said amount, and which waiver shall be <br />affective only upon receipt of payment thereof by the undersigned: <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Dollars ($ <br />by acknowledged; or <br />The payment of which has been promised as the sole consideration for this Affidavit and <br />Final Waiver of Lien which shall become effective upon receipt of such paymenat. <br />THEREFORE, The undersigned wiaves the releases unto the Owner of the said premises, any and all <br />lein or claim whatsoever on the above -described property andimprovedments thereon on account <br />of LABOR or matieral or both, furnished by the undersigned thereto, subject or conditions expressed <br />herein, if any: and further certifies that no other party has a claim or right ��Ii��IrtiH�a)�pount of any work <br />performed or material furnished to the underisgned for siad pr, aid prQjet, and witiin.'� cope of this affidavi <br />` �` <br />and waiver. .r d <br />rr: <br />_Q tT a_ <br />7 <br />Slatile Roofing & Sheet Metal Co. Inc. B Title: President <br />(Firm) (Authorized Repres ativ) <br />WITNESS MY HAND AND D NOTARYw SEAL day of , 20, <br />TARA L REINHARDT <br />NOTARY PUBLIC <br />SEAL <br />STATE OF INDIANA <br />My commission Expires: 12 18 2 21X COMMISSION EXPIRES DECEMBER 18,202� inted: <br />COMMISSION NUMBER NP0724157 <br />Residing in St Joseph County <br />(NOTARY PUBLIC) <br />ra Reinhardt <br />