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Final Waiver of Lien <br />State ofIndiana, County of _ 7E 1K1-1014- SS: <br />being duly sworn that he/she is they t c_e_. �t e.S► er <br />(Name of Officer) (Title) <br />Of (L LE EY AVATT-m1-, ZMc having contracted with City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials andlor labor as follows-, <br />(Description) <br />for a project known as _ Pier o;,r <br />(Name of Project) <br />located at R 2 o W . C c kVe.,e-L �X ►ye, 5v�,4- -& ,-A <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 <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 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 />AAsnclru4 1]rnz,�-e 41,reo �1rDD ($74te 3.qx) <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 sbali <br />become effective only upon receipt of such payment. <br />THBREFORE, 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 as account of labor or material or both, famished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a <br />lien on account of any work performed or material famished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lien. <br />E 1E�(G4Vta.�tin ANC.. <br />(F I_ M E L D A L D E L Authorized Representative) <br />STATBOFINDIANA ) �blic. Stale of Indiana <br />�; i +khartCounty <br />SS: , . ,-ission#696906 <br />ST. JOSEPH COUNTY ) emission Expires <br />Before me, the undersigned, a N Public In and for said Ala lly appeared <br />and acknowledged the execution of the fbragoffg—A]TkfaviFaff d. Waiver of Lien. <br />INIWHMSS WkI1;1tEOF, I have hereunto subscribed my ame and affixed my o cial seal on the r day of <br />Z82( I i I �4h wz�) - <br />bllc Si <br />My Commission Expires: d-` a V <br />Residing in fA-lw�- County, Notary Public Name <br />