PCA - Ritschard Bros - Demo of Vacant & Abandoned Houses, Phase VIII, Division D

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nu8. t. Lvvo 3;4)rivi If HP rvtl WUM 5 SAhEIY No.5866 P. 2 AFFIDAVIT AND 'WAIVER OF LIEN State of Indiana, County of St. Joseph SS: Rachelle L. Dolniak being duly sworn that he/she is the President (Name of Officer) (Title) of Ritschard Bros., Inc. having contracted with (Subcontractor/Supplier) to furnish certain materials and/or labor as follows: for a project known as Demolition of Vacant City of South Bend, Indiana (Contractor) of 7 Houses' (Description) Houses. Phase VIIT. Division D located at Various Addresses in the City and owned by City of South Bend (Owner) and does hereby further state on the behalf of the aforementioned subcontmctor(supplier: (PARTIAL WAIVER) that there is due from the Contractor the sum of Dollars (S ) ❑ receipt of which is Hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given. solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by she undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of Ninety—four.. Thousand Nine Hundred Twenty—six Dollars -------------- -------- ($94,926.09 ❑ receipt of which is hereby acknowledged; or -_ ... . ❑ the payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver ofLien which shall become effective only upon receipt of such payment TBEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever on the above -described property and improvements thereon an account of labor or material or both, famished b the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certified that no other party has any claim or right to a Hen on account of any work performed or material furnished to the understaled for said project, and within the scope of this Affidavit and Waiver of Lien. Ritschard Bros., Inc. By (Firm) (Authorized Representative) STATE Of INDIANA ) ) SS: ST. JOSEPH COUNTY ) Before me, the undersign4 a Notary Public, in and: for said County and State, personally appeared Rachel le L. Dolniak and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. IN WITNESS WHEREOF, I have hereunto subscp'bed my triune and affixed my offi ' seali the 30th day of April \` �p R2GYb . moo' S OTANotary o Public Si `_n'c My CommissionExpires: 9 / 18 / 17 = 08UG � Robin Fozo. Residingin St. Joseph County, Ind,' Notary Public Name