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AFFIDAVIT AND WAIVER OF LIEN <br />FINAL PARTIAL aPAYMENTTO FOLLOW <br />State Of Indiana, County of St. Joseph SS: <br />Michael Jackson being duly sworn states that he is the Controller of <br />Slatile Roofing & Sheet Metal Co., Inc. <br />(Subcontractor/Supplier) <br />Furnish certain materials and/or labor as follows: <br />located at: 3607 S. Main St. <br />(Contractor) <br />Roofing and Sheet Metal <br />For a project known as Nexus Center <br />and owed by City of South Bend <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 />ollars ( <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 />ars and 05/100 <br />Receipt of which is hereby acknowledged; or <br />tars ($ 9.849.05 ) <br />XXThe payment of which has been promised as the sole consideration for this Affidavit and <br />Final 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 project, and within the scope of this affidavi <br />and waiver. <br />Slatile Roofing & Sheet Metal Co. Inc. <br />(Firm) <br />WITNESS MY HAND AND D NOTARYSEAL, <br />My commission Expires: M/'Z�_X�U3U <br />Residing in County <br />BY • Controller <br />4fahnri,' <br />ed R4n,.,,tative) <br />this :` � / day of 20, 3 <br />NOTARY P BLIC) <br />�`��. Printed: Amy Marquez <br />