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Final Waiver of Lien <br />State of Indiana, County of S V/OSE z� SS, <br />rS toe 2!�-— being duly sworn that he/she is the <br />{Name of O r) (Title) <br />1 36MIi,, mF <br />Of TN6'R48 1CT !{�f cb�oni _ having contracted with 'Ve 4 saw> Lac W CKS <br />(Contractor) (Owner) <br />to lft mash certain materials andlor labor as follows; S 1TG e1r wwr e Con1s � 0 a <br />(Description) <br />for a project known as <br />located at <br />and owned by <br />FA <br />t- <br />(Name <br />(Owner) <br />and does hereby Anther state on the behalfofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />❑ receipt of which is hereby acttmowlodged; or <br />14 <br />Dollars <br />❑ the payment of which has hoop promised as the sole consideration for this Affidavit and Final Waiver ofLfenwhich is given <br />sololy with respect to said amount, and which waiver shall be 80e31vo only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due &oam the contractor is the sum of <br />❑ receipt of which is hereby acknowledged; or <br />❑ the payment of which has been promised as the sole consideration for this Aftldavlt and Final Waiver of Lien which shell <br />become effective only upon recolpt of such payment. <br />THBREFORE, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above-deserlbed property and improvements thereon as account of labor or material or both, furnished b the undersigned <br />thereto, subject to ihmitations or conditions expressed herein, if any; and further certified thatno other party has any claim or right to a <br />Zion on account of any work perfomed or material furnished to the undersign or said -ect, and within the scope oftbis Affidavit <br />and Waiver of Lien. <br />Ro&e*-T By t� <br />u) m (Authoriz presentative) <br />STATE O INDIANA ) <br />SS; <br />ST. JOSEPH COUNTY ) <br />Before nee, the undersigned, a Notary Public, In and for said County and State, personally appeared <br />and acknowledged the oxecuflon of the foregoing Affidavit and Waiver of Lien. _ <br />IN WITNESS WHMOF, Ihave hereunto subscribed my name and affixed my official seal on the day of <br />200 <br />Notary Public Signature <br />My Commission Expires; <br />Residing in County, -- - Notary Publio Name <br />ri <br />Al <br />