Laserfiche WebLink
Final Waiver of Lien <br />Mabee oflradiana, County of r, e r/t SS <br />ram ;gip kI, y <br />bale duly sworn that he/site is the <br />/ (Name of OfAcer) (Title) <br />of far t? � a c ' , having contracted with e" 16,41 <br />(Contractor) (Owner) <br />to famish certalft. materials and/or labor os follows: <br />(Description) <br />for a project known as � � � c' � � .t L) v- <br />(Name of Project) -- <br />located at <br />and owned by i` a <br />(Owner) <br />and aloes heraby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAPMR) that there is date from the Contractor the sure of <br />Dollars $ <br />El receipt of which is hereby aclulowlodged; or <br />the payment of which has been promised as the sole consideration for this Affidavit and final Waiver ofLion:-which is given <br />solely with respect to said amount, and which waiver shall be effeaive only upon receipt of payment thereof by the <br />undetiignedp <br />(FINAL W IVEA) that the final balance clue from the contractor is the sure of <br />V % '1 <br />El receipt of which is hereby acknowledged, or <br />JD`/the payment of which has been promised as the sole consideration for this Affidavit and Final Walver 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 an account of labor ormaterlat or froth, flami'shed 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 />Jim on account of any work perrouned or material famished to the under°cigar sae proJed and within the scope of this Affidavit <br />and Waiver ofLlen. <br />C TI Z__L <br />(Firm) w . Alexandra Mitchell, Notary Public (Authorizedltepresentative) <br />STATE OF �►IANA ) SS. �° " Comm. Expires Oct. 12, 2025 <br />SEAL Resides in St. Joseph Co., IN <br />ST, JOSEPH COUNTS Comm. N'urnber 706417 <br />Before me, the undersigned, a Notary .Public, In end for said County and State, personally appeared � m <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />y t seal on the day of <br />�IN T.C�I'l;S �IiEOF ilravo Frtsrotrttto subscribed� nararo and axed oflici M . CIO <br />° <br />a <br />t^lotury Public Signature <br />112y Commission Extires <br />k"'YA? <br />itesldingin� �'ty <br />oust '. <br />/t � i+ictaryPublici'4iama; <br />