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State of Indiana, County of <br />Final Waiver of Lien <br />`>+. .V) 5f n n— SS: <br />(Name of Officer) <br />VA of . <br />(Contras- tor) <br />being duly sworn that he/she is the <br />(Title) <br />having contracted with &A &'� <br />„ 1 „ (Owner) <br />to furnish certain materials and/or labor as follows: I?s? CZ�— <br />( (Description.)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 />Dollars $ <br />❑ receipt of which is hereby aclntowledged; nr <br />❑ the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver of'Lienwhich is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt ofpayrnent thereof by the <br />undersigned; <br />FINAL WAIVER) that the final balance due from the co tractor is the sum of <br />e � 73 <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 />TMREFORE, the undersigned waives and releases unto the Owner ofsaid 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 party has any claim or right to a <br />lien on account of any work performed or material furnished to the undersigned for said project, and within the scope oftWs Affidavit <br />and Waiver of Lien. <br />Ief�l- jZt1�� ��o7Sfl-�ct�tz�n iG•�1�iC' By <br />�) (Authorized Representative) <br />STATE OF IMIA 4A ) <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 named affixed my official seal on tho day of <br />()Ve y\ belr 20 202 <br />Notary Public Signature <br />My Commission Expires: <br />Residingin �Y1G1�'� County, �l�C� rj� -- <br />RACHAE EL IS erne <br />Notary Public, State of Indiana <br />=z:SEq�:� Marshall County <br />;* • * commission Number NP0744094 <br />My Commission Expires <br />October 03, 2030 <br />