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P,i,l Milestone <br />AFFIDAVIT AND WAIVER OF LIEN <br />STATE OF INDIANA <br />SS: <br />COUNTY OF MARION <br />PARTIAL <br />Payment to Follow <br />Jen . Timmons being duly sworn states that he is the Project Accountant of Milestone Contractors North, Inc. <br />having contracted with CITY OF SOUTH BEND, INDIANA to furnish certain materials and/or labor as follows: <br />ASPHALTJCONCRETE/ PIPE for a project known as RANDOLPH STREET PARK AREA IMP (MCLP Job# <br />229710) located at SOUTH BEND, IN and owned by SAINT JOSEPH and does further state: <br />PARTIAL WAIVER: that the balance due from the owner is the sum of one hundred thi .-two thousand four hundred nine '-one <br />and 74/100 Dollars <br />the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien <br />which is given to and for said amount, effective upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the <br />above -described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, -and <br />further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the <br />undersigned for said project, and within the scope of this affidavit and waiver. <br />Milestone Contractors North, Inc. <br />M <br />Jen . Timmons <br />Project Accountant <br />Subscribed and sworn to before me this: X th day of September. 2022 <br />Notary Public: <br />Alisha Krueg <br />My Commission Expires: June 5.2030 <br />ppY P�j�4•• ALISHA KRUEGER <br />. O <br />S? ' ,d• <br />NlY C�ommis810D Expires <br />County of Residence: La Porte ,:SEAL Q1 <br />.+ .. o:F.• <br />June5, 2030 <br />C.onu bft Number NPM63544 <br />o€ ,,• <br />La Ports Count' <br />