Laserfiche WebLink
Final Waiver of Lien <br />State of Indiana, County of <br />SS: <br />f �l 0 l IX being duly sworn that he/she is the O v DI _ <br />(Name of officer) ` (Title) <br />of S`I neat r 1`CC V�(Jl_'f' 00 having contracted with City of South Bend <br />(Contractor) LL (Owner) <br />to famish certain emnterlals and/or labor as fa3lows; POI)CPA1 to P[ of (f . S0 r- -a G1 n <br />(Description <br />for a project known as Sy"L+�nec c't Qar)< <br />(Name of Project) <br />located at 0� 101 5. St . L.p to 1 S 13J A a e v d+ 1 4 b b 1 "7 <br />and owned by _ City of South Bend <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 sum of <br />Dollars (S <br />❑ receipt of which is hereby aclntowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver ofLienwhich 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 WAIVER) that the final balance due from the contractor is the sum of <br />❑ receipt of which is hereby acimowledged; 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 onlyuponreceipt 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, AmAshed b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and farther certified that no other party has any claim or right to it <br />lien on account of any work performed or material banished to the undersigned for said praj ct, and within the scope of tbis Affidavit <br />and Waiver of Lien. l <br />51 A C 106 ( �C.1'�01`l i 6 /1 By <br />(Firm) (A6thdflzed Representative) <br />STATE OF DMIANA ) <br />) SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared 7 <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 official seal on the /d - day of <br />0trfX#C _ 2023 <br />� 1 5igaa <br />My Commission Expires: D /— / 7- Ze ZS- <br />Residing in 6 mNw¢ County, Notary P bh0 N t:t t SS <br />Notary Public, State of Michigan <br />County of Ottawa <br />My Commission Expires January 17, 2025 <br />Acting in the County of _f�7 s+¢s•,7 <br />