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State ofludiana, County of LK qLk� SS; <br />IM &Y VMV44 being duty sworn Via t�i she is theyi u 'Raid to p <br />(Name of Ofpeer) (Title) <br />of rat, t n w4It tori� having contracted with Der 2 utA Penal <br />(Contractor) (Owner) <br />to furnish ce►taln materials and/or labor as follows; G r Corls%rur�e� rY� }triaq y P <br />for a project known as <br />locAted at <br />D•r <br />and does hereby fi►rther state on the behalf ofthe aforementioned subcontractor/supplier; <br />(l'ARxIAL WATVBR) tl►at there is duo from the Contractor the corn of <br />❑ receipt of which is hereby acknowledged; or <br />[a 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 which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />that the final balance due S•o►n the contractor is the stun of <br />..r <br />at 1 <br />❑ receipt of which is hereby aclrnowledged; or <br />[U0the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall <br />become effective only uponreccipt of such payment. <br />THEREFORE, <br />the undersigned waives and releases unto the Owner of sold premises, any and all liens or claims whatsoever <br />en the above -described properly and improvements thereon au account of labor or material or both, furnished b We undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified thatno other party has any claim or right to a <br />lion on account of any work performed or material furalshed to the undersigned for said project, and wlthin the scope of this Affidavit <br />and Waiver of Lien. <br />STATE OF • <br />sst <br />STo JOSEPH COUNTY <br />]Before me, the undersigned, a NowryK. <br />and acknowledged the execution :.. <br />in WITNESS WHEREOF,: .'d my name and affixed my officialon the day o <br />20213 <br />lvly Commission fixpiras: awl �i � � �_� ��-� . <br />Residing in L , County, . W Dl R �3j� <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />i SEAL <br />I ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRdJARY 12, 2026 <br />COMMISSION NO.710399 <br />