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.710399 <br />State oflndiana, County of El101ay+ SS: <br />M Qu y{g, 4 being duly sworn iha he he is the V t LQ — Pyesid eni <br />(Nat e ofOffieer) (Title) <br />of &tDC r&M GnQyie riiu5 Inc, having contracted with DF.Sotd'II germ <br />(Contractor) (Owner) <br />to flunish certain materials and/or labor as follows: <br />for a project known as <br />and Si, <br />located at various to hf ns <br />and owned by <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supp4er: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars ($ ) <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which has boon 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 WAIVER) that the final balance due Ron the contractor is the sum of <br />_($ <br />receipt of which is hereby acknowledged; or <br />Ddthe 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 -described property and improvements thereon an account of labor or material or both, furnished 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 of Lien. <br />bemium ay <br />(Firm) (Authorized Representative) <br />STATE OF INDIANA ) <br />�fkrlflrr ) Ss: <br />-8=0911R I COUNTY ) r <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared t rr 1 X \ l <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. ��-��� <br />IN WITNESS WHEREOF, I Lave hereunto subscribed my name and affixed my official seal on the day of <br />:3�i ISE 2ae !L3 <br />Notary Public signature <br />My Commission Expires; O4 ( <br />�A�1 CC TC� IJ CPS <br />Residing in}IA?_-T County, TN�I AtJA Notary Public Name <br />