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Final Waiver of Lien <br />State of Indiana, County of . i°� SS: <br />�LA9 A.,�~�� being duly sworn that he/she is the <br />(Name of Officer) (Title) <br />of �� 2 /g aving contracted with Gi TY 0 'S tom, /O 6 <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; <br />m....._... (Description) <br />for a project known as Sc '✓ ,e 1� P , c 4:5/.6�? � <br />(Name of Project) <br />located at OF <br />and owned by <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the suns of <br />Dollars ($ ) <br />❑ receipt of which 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 is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payinent thereof by the <br />undersigned; <br />(FINAL WAIVER that the final balance due e s of <br />rw � � m the contrAL <br />ry— <br />❑ receipt of which is hereby aalmowledged; 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 />" 1113REFORE, the undersigned waives and releases unto the Owner ofsald pronAlses) any anti all liens or claims whatsoever <br />on the above -described property and improvements thereon an accowit of labor or material or both, Runished b the trtwderslgned <br />thereto, subject to limitations or conditions expressed herein, if any; and further ortified that no other party has any claim or right to a <br />lien on account of any work perfornwed or material Aintished to the undersigned for said project; and within the scope of this Affidavit <br />and Waiver of Lien. <br />l <br />(Finn) on ed Representative) <br />STATE OF INDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared i ot•(n( A, t Rj2v <br />and acicnowledged the execution of the foregoing Affidavit and Waiver of Lien, <br />IN WITNESS WBEREOF, I have hereunto subscribed ttty name and affixed my official seat on the Zo 7"" day of <br />Notary Public Signature <br />My Commission Expires:�z zo <br />Residing in 57- � _m. County, etl r Notary Public Name <br />