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AFFIDAVIT AND WAIVER OF LIEN Ok-21.) State o � County of -�...L....C-:.""":...;.'-=i:;._, [_;_, �-------SS:__,;:G;;;._..;;...�-'--1-4"--'�;;;:;;.:::..;.;;..sf.,.;;;__'-t'_,_." ___ being duly sworn thath@is the Pto�«J Qee owd-a.J(Name ofOfficor) (Title) of _,CloLx...l.m�--e'--,Lc��-=s�c.-=:o;;..__ __ having contractod with c_·, � a£& J;-1-i ... &✓. 1,;(Subcontractor/Supplier) ..J¥-(Contractor) 1 <br />M.a� C\-l-en4,,c.e �e Obie&-/to furnish certain materiala and/or labor as follows: ·on) <br />ffiotr-·�:s f¥'otrV-•:j at:✓S C�-lrcfor a project known as <br />located at <br />and owned by (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 <br />0 receipt of which is hereby acknowledged; or ($ <br />0 the payment of which bas been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given solely with respect t.o said amount, and which waiver shall be effective only upon receipt of payment thereof by the IDldmigned; :mw �that � pnA1 ba.lall� 4_ue ,vom the co�actor is the sum of () �" ':::}t.ey,e,8'4.+��"='4�•Jf bw-Jttti�-dJt!s Sb<is,fALII, D <br />0 receipt of which is hereby acknowledged; or <br />� the payment ofwhlch bu been pr omised u_the sole con.1idcl"llion for this Affidavit and Final Waiver of Lien which shallbecome effective only upon receipt of such payment <br />THEREFORE, the 1DJdersigMd waives and releases unto tho Owner of said premises, any and all liens or claims whatsoever on the above-described property and Improvements thereon an account oflabor or material or both, furnished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any cl aim or right to a lien on account of any work performed or material furnished to the undersigned or ,ajd proj and withln the scope of this Affidavit and Waiver of Lien. <br />(1Y\ -e� 0(F irm) STATE OF Hffl�u\ /).>._ii) ) .-:-_ I. I ) SS:. ST J98BPH GOUNn' �; � .LI Before me, the undtnigned, a Notary Public, in and for said County and Stat.e, personally appeared -'L,la.��(. 14-�=�)l.4"-• ,,., and acknowledaed the eitocution of tho foregoing Affidavit and Waiver of Lien. :=wi IN WllJ'IBSS WHF.REOF, I have hereunt.o aubscnbed my name and affixed my official seal on the�MC"--��o� � <br />My Commission Expires: 7(}{).,,1c A_ ;;i. i� oJo.). < <br />Residing in -G-ovll.J:J, ,'\ County, r) k_2 0 <br />COLLEEN LORMS <br />Notary Public <br />State of Oh.I My Comm. Expires <br />March 25, 2025 <br />Notmy Public Signature <br />Notary Public Name