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Final Waiver of Lien <br />State ofludiana, County of St. Joseph <br />Ruben Alvarado being duty sworn that he/she is the <br />(Name of Officer) <br />of Rieth-Riley Construction Co., Inc. <br />(Contractor) <br />to furnish certain materials and/or labor as follows: <br />for a project known as <br />located at <br />and owned by <br />SS: <br />Sales Manager <br />(Title) <br />having contracted with City of South Bend <br />(Owner) <br />Roadway Improvements along Locust Road <br />(Description) <br />123-018 Locust Road Improvements From Assumption Dr to State Road 23 <br />Assumption Dr. to State Road 23 <br />(Name of Project) <br />City of South Bend <br />(Owner) <br />and does hereby Anther 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 acluiowledged; 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 shall 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 />❑ receipt ofwhich 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 as account of labor or material or both, furnished b the undersigned <br />thereto, subj ect to limitations or conditions expressed herein, if any; and further certified th 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 sai ject d wl o e of this Affidavit <br />and Waiver of Llen. <br />Rieth-Riley Construction Co., Inc. By <br />frill (Authorized Representative) <br />STATE OF MDIANA ) ) <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the 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 affixed offic• 1 seal on a 28 da <br />May 202 4 <br />otary, P lic Signature <br />ivly Commission pines: / <br />r Wl" r, 'k <br />Reesiding in ( County, DAWN <br />�`�?.••��e° Notary Public, state of Indiana <br />,G <br />-2'SEAL;"" Kosciusko County <br />t'•, t; Commission Number NP0734858 <br />ti�iANP My commission <br />Expires <br />