Laserfiche WebLink
AF-FIDAVIT AND WAIVER OF LIEN <br />d <br />FINAL PARTIAL �PAYMENTTO FOLLOW <br />State Of Indiana, County of St. Joseph SS: <br />f i 1.Olhc��C being duly sworn states that he is the.�P�. of <br />Slatile Roofing & Sheet Metal Co.. Inc. <br />(Subcontractor/Supplier) <br />Furnish certain materials and/or labor as follows: <br />(Contractor) <br />Ma �,n n,w a -(1 A <br />For a project known as h\ Q A L <br />located at: �;� trl�> 61("� - (� and owed by �\1111�(1 Ufd <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 ($: <br />Receipt of which is hereby acknowledged: or <br />The payment of which has been promised as the sole considertion ofthis Affidavit and Partial <br />Waiver of Lien which is given solely with respect to said amount, and which waiver shall be <br />affective only upon receipt of payment thereof by the undersigned: <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />T t Ko'_Y 4Cc_tCl��s;t�:i'�ti Sri ° -�c�l :� (`ICY-4Dollars ($ <br />Receipt of which is hereby acknowledged; or <br />0he payment of which has been promised as the sole consideration for this Affidavit and <br />dFinal 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 to lien on account of any work <br />performed or material furnished to the underisgned for siad pri aid prpotr)i;Yrydlithin the scope of this affidavi <br />and waiver. <br />Slatile Roofing & Sheet Metal Co. Inc. By Title- 4i� <br />(Firm) (Authorized Rep _ +?ntativS)� P z <br />WITNESS MY HAND AND D NOTARY SEAL, this��� dar�jb c�c 20 <br />COMM: 669400 (NOTARY PUBLIC <br />My commission Expires: June 21, 2023 Printed: Michelle McIntyre <br />Residing in St. Joseph County State of Indiana <br />