HomeMy WebLinkAboutProject Completion Affidavit - C&S Masonry Restoration LLC - Leighton Plaza Improvements Phase 2 Division B - Project No 117-054RI 1
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Final Waiver of Lien
State ofindlana, County of SS:
being duly sworm
s f _ ► that he/she is the We's y ci'e^^ —
(Name of OfficerY)! - (Title)
of S vv'"e'`�L�! / having contracted with _C_ ► 'Y o v "
(Cantractax) T (Owner) .""°....
to Tarnish cortala materials and/or labor as follows: 2+1/ �7+t' D� t2 tt �4-/-e:.1-S
(Description)
for a project known as
located at
and owned by
1. e- 14 z'Gw) 4) [+L►A- / At � e
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and does hereby further state on the behalf ofthe aforemenfloned subconttactor/supplier,
(PARTIAL WAPAW that there is due from the Contractor the sum of
Dollars
Q receipt of which is hereby aolsnowledged; or
[� the payment of which lies been promised as the sots consideration for this Affidavit and. Final Waiver ofLien-which is given
solely with respect to said antouat, and which waiver shall be effective only upon receipt of payment thereof by the
undersigned;
AL VAI'V124) thatJhe final due from the contractor is the am of
❑ receipt ofwhieh is hereby acknowledged; or
E3'/ the payment of which has boon promised as the sole consideration forthis Affidavit atnd Final Waiver of Lien which shall
became effective only upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the owner of said premises, any and all liens or claims whatsoever
on tho above-deserlbed property and improvements thereon an account of labor or material or both, furnished b the undersigned
thereto, subject to limitations or conditions expressed herein, if any; and further certMed ihatno other party has any claim or right to it
Ron on account of any work per£coned or material famished to the undersigned for said projec4 and within the scope of this Affidavit
and Waiver ofLlen.
(Fi(Authorized Representative)
STATE OF iNDU1d+lA )
SS:
ST. J'OSEPH COUNTY
Before me, the undersigned a Notary Public, in and for said County and State, personally appeared � /Li � )J--5
and acknowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS OF, I have hereunto subscribed my name and affixed my official seal on the day of
Notary Public Signature
MyCon=fsafoftExpires: -sue4/i L'
Residing in County, No pubi#o Name-
dRSFf/1 �, f3��OWN
NOTARY PUDLIC
SEAL.
STATE OF INDMA
COUNTY OF ST JOSI_:PH
Illy n�rhriii� yiUn Fx��fr�3s,l�ane �B ?02