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AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of SS: <br />being duly sworn that he/she is the �� S <br />(Name of Officer) (Title <br />of V <br />having contracted with <br />(Sub ntractor/Supplier) (Contractor) <br />to furnish certain materials and/or labor as follows: eC� <br />(Description) <br />for a project known as // I'7 <br />(Name of Project) <br />located at <br />and owned by D <br />(Owner) <br />SUE ANNE CIRA <br />and does hereby further state on the behalf of the aforementioned subcontractor/supplier: Seal <br />Notary Public - State of Indiana <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of St Joseph County <br />My Commission Expires Oct 22, 2022 <br />Dollars $ <br />❑ receipt of which is hereby acknowledged; 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 shalt be effective only upon teceipt of payment thereof by the <br />undersigned; <br />1VE- at the al ba:larrce due from he <br />c aetor is t e sum of <br />0 0 <br />ipt of which is hereby acknowledged; 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 />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 thercon an account of labor or material or both,, furnished 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 />lien on account of any work performed or material furnished to the undersigned for said project, and within the ,scope of this Affidavit <br />and. Waiver of Lien. <br />-`�A"'i �" sf �. !nc By <br />um ty <br />STATE OF 1NDIANA ) ) � P � �A'e-S'� <br />S'S: <br />ST. JOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared,�.?�_ r, /47k <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WI S WHEREOF, I have hereunto subscribed my name and affixed mzoary <br />ffiil seal on the day of <br />Public Signature <br />My Commission Expires: 1 la X, 2 Q , <br />Residing in 1JA County Notary Pu Na e <br />