Laserfiche WebLink
AFFIDAVIT AND WAIVER OF LIEN <br />State of Indiana, County of 0 In <br />SS: <br />An ibg nq being duly sworn that he/she is the <br />(Name b,f Officer) (Title) <br />of Aff.,UZ,& / contracted with ,O�aving, <br />(Subcontractor/Supplier) (Contractor) <br />to furnish certain materials and/or labor as follows: <br />(Description) <br />for a project known as <br />located at <br />111� <br />A 2 G1, iyarxl"Wj; <br />(Name of Project) <br />and owned by <br />(Owner) <br />and does hereby Rather state on the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVER) that there is due from the Contractor the sum of <br />Dollars <br />11 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 I ien which is given <br />solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) that the final balance due from the contractor is the sum of <br />Ar�11�11 AjeegM1110 <br />O� 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 shall <br />become effective only upon receipt of such payment. <br />THEREFORE, the undersigned waives and releases, unto the Owner of said premiscs, any and all licips or claims whatsoever <br />on the above described property and improvenients thereon 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 riglit 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 />I M TIM I M M 0- IN I I ME RM. 11M, M <br />By <br />I b U11 I b I <br />(Authorized , presentative) <br />A NWANA <br />$S: <br />ST. JOSEPH COUNTY L. <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared iF-J on <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. I <br />A IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day of <br />My Commission Expires: <br />IDA M*IEE-L—ER1DENO1JR <br />Notary Public - Seal Ns wary Public Signature <br />State of Indiana <br />St Joseph County <br />RksJDalWes Oct 7, 2021 <br />Residing in County, <br />—Indiana --�Zotary Pu �Iic Name <br />