Laserfiche WebLink
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, 2026 <br />COMMISSION NO, 710390 <br />State oflndiana, County of ELJ(kAk.T SS: <br />`4 EA K>r� being duly sworn thathe/she is the <br />(Namr�ea�o`f0ificer) (Title) <br />of �REitlIU41�St►I.11 l�—I:yl(jr having contracted with City of South Bend <br />(Contractor) Moe% _ (Owner) <br />to fumis]r cettahr materials and/or tabor as follows; <br />for a project known as <br />located at � AR1 ous N Ct e�H DoRH T!{ SOLll j"UTA I Sm SouTN ! /& AJ U <br />Bend <br />and does hereby further state on the behalf of the aforementioned suhconttactox/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />❑ receipt of which is hereby nclmtowledged; 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 WAIV )that the final bal ce dum g �,the contractor is a sum of <br />�ltltJ� r� cA6Tiacu5AN0� <br />❑ receipt ofwhich 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 only 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-descrlbedproperty and improvements thereon an account of labor' ox material or boot, furnished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and f irthor certified thatno other party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for saidpr loot, and within the scope of this Affidavit <br />and Waiver ofLlen. <br />tT.rMMYl �i�( 91t S 9VI C5 , TNC . By <br />nm) (Authorized Representative) <br />STATE OF INDIANA <br />COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared MA1VuA tom' f` <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 f'1 day of <br />CTCIlai�(2 200 •Dn <br />N tary Public Signature <br />My Commission Expires: oaLa lapa-� Signature <br />�t �A� Conn .7kc N • ota) P, <br />Residing in <br />County, 1J01 K)Nfl Notary Public Name <br />