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SS:LaPorteCounty of <br />PartialState of SS:Indiana <br />Final X <br />WAIVER OF LIEN <br />XPayment to Follow <br />and does hereby further state on behalf of the aforementioned Contractor , <br />PARTIAL WAIVER that there is due the sum of <br />receipt of which is hereby acknowledged: or <br />the payment of which has been promised as the sole <br />consideration of this Partial Waiver of Lien which is given solely <br />with respect to said amount, and which waiver shall be effective <br />only upon receipt of such payment. <br />FINAL WAIVER <br />receipt of which is hereby acknowledged: or <br />the payment of which has been promised as the sole <br />consideration of this Final Waiver of Lien which shall become <br />effective only upon the receipt of such payment. <br />that the final balance due is the sum of <br />THEREFORE, the undersigned waives and releases existing liens, rights and claims to the extent of payment <br />only for labor, material, equipment or any combination thereof, furnished to the OWNER of said premises for <br />improvements thereon.Company: <br />By: <br />WITNESS MY HAND AND NOTARIAL SEAL , THIS DAY OF <br />My Commission Expires: <br />Residing in: <br />Notary: <br />Printed Name: <br />$8,991.71 <br />X <br />Whereas, the undersigned,LARSON-DANIELSON CONSTRUCTION CO., INC.,having been employed by <br />SOUTH BEND, CITY OF to furnish certain Material and Labor , to wit: <br />LARSON-DANIELSON CONST. CO. INC. <br />SOUTH BEND, CITY OF and located at: <br />Century Center Skyway North Restroom Renovation Per Plans, Specs and Contract for the building owned by: <br />120 DR MLK JR BLVD SOUTH BEND, IN 46601 <br />eight thousand nine hundred ninety-one and 71 / 100 <br />Heather R. Brown, Controller <br />02/10/2027 <br />LaPorte County Stacy L. Bibian <br />19 February 2024 <br />Notary No.624018 <br />CITYSB00 <br />56668-00004 <br />56-668Job : <br />Customer: <br />Invoice: