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AFFIDAVIT AND WAIVER OF LIEN <br />0", c' <br />State o County of�DSS: <br />G' P, - being duly sworn that h sh is the ` (�pai I a Lo� D LI'Ja <br />(Name of Officer) I l / (Title) <br />of Q. F�-(?(` -P 0 having contracted with l _rl It / f �y u`� -f, �� . <br />(Subcontractor/Supplier) (Contractor) <br />to fumish certain materials and/or labor as follows: M p L A e <br />for a project known as <br />(Name of Project) <br />located at <br />and owned by <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 />❑ receipt of which is hereby acknowledged; or <br />e n . .,4 7 <br />Dollars (S j <br />❑ 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 />AL WAIVER that the baJanr ue from the contractor is the sum of <br />vF' u nd � � & �� QTI'j-tine S( S 6 f�Q� 06 <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 parry has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said proje , and within the scope of this Affidavit <br />and Waiver of Lien. <br />CkN ere'Y 0 By 7 <br />(Firm) (Authorized Representative) <br />STATE OF X O ) <br />SS: <br />Before me, tho undersigned, a Notary Public, in and for said County and State, personally appeared <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and of ixrd my official seal on the day of <br />J/ <br />Notary Public Signature <br />M <br />y Commission Expires: , <br />Residing in k 01 ✓t County, Notary Public Name <br />COLLEEN LORMS <br />Notary Public <br />° <br />State of Ohio <br />c, ' • :. - .�»' c <br />My Comm. Expires <br />>'_4ra• "' o <br />March 25, 2025 <br />