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Final Waiver of Lien <br />0Htn <br />State of-hMVsa, County of m i Lrb SS: <br />4c��C : f-at%,'A � t>T-12 being duly sworn that he/she is the iPr2 6 610 , IN 7- <br />{Name of Officer) (Title) <br />of LEc6a A1-i lky v:mpzc,�-S ; /ev having contracted with CiN of South Bend _ <br />(Contractor) (Owner) w <br />to furnish certain materials andlor labor as fcllowst W tl'l'F r "4 0 .- S t.p N riy E C by or- 5 o v `re t S E 'P <br />- (Description) <br />for a project ]mown as <br />(Name of Project) <br />located at - C t TLl OF SO v-T H f5 E VOD r 1 U D l to f VA <br />and owned by City of South Bend <br />(owner) <br />and does hereby further state on the behalf of the aforementioned subcontractor/,UWW. <br />(PARTIAL WAIVER) that there is due from the Contractor the aura 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 Lienwhich 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) tAnt the final balance due from the contractor is the sum of t j "Q e ` h G , a <br />gi?)oio-:1-t7 hvhdvad ScXFyo,�e �} <br />❑ receipt ofwhich is hereby aclmowledged; 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-descrlbed 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 fhether 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 project, and wit1iln the scope of this Affidavit <br />and Waiver of Lien. <br />wDi�2►¢Pci 1AJDV5; n1ks' By ( , <br />(Firm) (Authoriz sentative) <br />STATE OF b i4 io ) <br />SS: <br />o A to Lt.fv ha ;OUNTY ) ' <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared 6rejq::q C. <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lion. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day of <br />-- A17 L 202� I <br />i <br />Notary Pu i Signature <br />My Commission Expires: <br />Redding in tarn l u so r <br />�7RR7�JRf� fQC, i�Yl% a I �/lam✓��%`"'`, . <br />pip <br />f4 Comm eion Espiues: <br />02-2&2M <br />