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Final Waiver of Lien <br />State of Indiana, County of SS: <br />being duly sworn that he/she is the M RN ACsZ�C� <br />'Z c1. .LL (�C3rl 1A ld- (Title) <br />Of having contracted with G��� �� SON1 <br />(Contractor) C-tLOVP (Owner) <br />to famish certain materials and/or labor as follows: I '3m \l(Lv's I <br />(Description) <br />for aprojectlmownas F�t�q$-teu'E C�rnct'ti Sv�O�V\S\Oil Qo��ie"'t!Jo. w?1.\.-Qa-1 <br />(Name of Project) <br />located at U%(a s (X. c\3 s ov'iu, t S r4\3 \k 3'�+� A <br />and owned by pq^Z �� . L`.L �_ a �+uS P �—c- A�.\"'C`l e d Z Lo <br />(Owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the aum of <br />Dollars <br />❑ receipt of which 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 is given <br />solely with respect to said amount, and which waiver shall be of active only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVED that the final balance due ftni the contractor is the sum of <br />receipt of which 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 -described property and improvements thereon as account of labor or material or both, famished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and farther cartlfied that no other party has any claim or right to a <br />lien on account of any work performed or material Runished to the undersigned for said project, and wlthln the scope of this Affidavit <br />and Waiver of Lien. ` <br />P�►z��, vac.- a lit la L <br />By _ <br />i <br />(Firm) (Authorized Reproscaiativc) ; <br />STATE OF INDIANA <br />) SS: <br />ST. JOSEPH COUNTY _ <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared K, Qixr E <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affted my official seal on the day of <br />M /�1 200 1023 . <br />1 <br />No lgna <br />My Commission Expires: IMO. C4 2Z 202A,. <br />Residing in _ 5r -�Ok County, <br />eNu`Wt"tt� lug <br />BENJAM�NbMARLATT <br />Notary Public <br />State of Indiana <br />Commission No, 711569 <br />My Commission Expires <br />March 22, 2026 <br />