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State of Indiana, County of <br />Robert A. Lingenfelter <br />(Name of Officer) <br />of _ _Gibson -Lewis, LLC <br />(Contractor) <br />to furnish certain materials and/or labor as follows: <br />for a project ]mown as <br />located at <br />and owned by <br />Final Waiver of Lien <br />St. Joseph <br />being duly sworn that he/she is the <br />SS: <br />President <br />(Title) <br />having contracted with City of South Bend, Board of Public Works <br />(Owner) <br />General Construction <br />(Description) --.� <br />Muessel Grove Public Restroom <br />(Nam of Project) <br />1222 Wilber Street, South Bend IN <br />Citv of South Bend, Board of Public Works <br />—. - <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(R�. i$C�{iK►i(l�}}C9�IK ��'ACC:�f'Idh�#S�C�It}Glh(a�t�i'iilCil��of <br />— - _ Dollars $ <br />❑ receipt of which is hereby acluxowledged; 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 wbicla waiver sball be ef#ective only upon receipt ofpayment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Twenty Eight Thousand Five Hundred Thirty Six Dollars and 11/100 $2$ 536.11 <br />❑ receipt of which is hereby acknowledged; or <br />® thepaymeat of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become offective OHIy upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases unto the Owner ofsaid premises, any and all liens or claims whatsoever <br />on the above -described property and improvements thereon au account of labor or material or bath, furnished b the undersigned <br />thereto, subject to limitstions or conditions expressed herein, if auy; and "her certified that no other party has any claim or right to it <br />Hen on account of any worts performed or material Mrnished to the undersigned for said project, and wlthin the scope of this Affidavit <br />and Waiver ofLien. <br />Gibson -Lewis, LLC' By <br />'M (Authorized Representative) <br />STATE OF INDIANA ) Robert A. Lingenfelter, President <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared Robert A. Lingenfelter <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name an (fixed m official seal on the 27th day of <br />June 2n�t 23 - <br />r � <br />�v <br />otary Public Signah <br />My Commission Expires; August 5, 2023 <br />Rosidingin St. Joseph CountyIndiana ffaoaw�tVIEC St *k'TA i�y rumic. ate of indiano <br />ti st Joseph County <br />srA� . Commission M 671289 <br />�•' My Commission Expires <br />���'......i+ August 05, 2023 <br />