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Final Waiver of Lien <br />State of Indiana, County of 0-tali 5Y\ SS: <br />rV-) Lbeing duly sworn that he/she is the , <br />//����, aa Nfame oOfii ,r) (Title} <br />of l.�.s`.OAA ' i eXa�~Ct Paving contracted with <br />(Contractor) <br />to furnish certain materials anchor labor as follows; tteA co al r LPM <br />Q - (Description) <br />for a project known as C9 t <br />s (Name of Project} <br />located at I W ► ® , <br />and owned by <br />and does hereby I'iuther state on the behalf of the aforementioned subcontractor/supplier: <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 lies 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 sball be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL AIVFR) that the final balanc due from the contractor is the sum: of <br />_L$ Ili ()) <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 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 clainjm right to a <br />lien on account of any work performed or material furnished to the undersigned for said project, and within the sco this Affidavit <br />and Waiver of Lien. <br />(F) (Au zed Representative) <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 Nol a j ¢Seer y <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my a cial seal on the / h day of <br />My Commission Expires: <br />Residing in County, Notary Public Nacre <br />