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Final Waiver of Lien <br />State of Indiana, County of w « SS: <br />, <br />Joadi" Ct�l" being duly sworn that he/she is the <br />(Name ofOfrleer) <br />(Title <br />ofAYLle �, having contracted with <br />(i otttrar car`) ("Owner) <br />to furnish certain materials and/�l labor as follows,,e „ " �+ 'pf d d4 /Wj k.5 <br />j (Description) �!L <br />for a project known as %13 <br />located at <br />and owned by <br />and does hereby further state on the behalf ofthe aforementioned subcontractor/supplier: <br />(PARTIAL WAMR) that there is due from the Contractor the sum of <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 sball be eiiootive only upon receipt of payment thereof by the <br />undersigned; <br />(FINAL WAIVER) th=finae due from the coo ct is to s of � µ �a . <br />_._ _ <br />r .�. 3 <br />❑ receipt of which is hereby acknovrledged; or 77Mr <br />Xthe 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, ally and all liens or claims whatsoever E <br />on the above-descrlbodproperty and Improvements thereon as account oflabor 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 clalin or right to a <br />ilen on account of any work performed or material flrrttished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver ofLlem w <br />�./nc, By <br />(Firm) rt re ntativ) <br />STATE OF INDIANA <br />SS: t <br />ST, JOSEPH COUNTY ) ,/ <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared, S�v4 <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />I WITNESS WBEItEOF, I ,have hcrounto subscribe name a d Mad my official al on the �� ay of <br />Notary Public Signature; <br />My Commission Expires: Lag a a. a <br />Residing i 0 , l County, 1nG� c al2Gy <br />SUE ANNE CIRA <br />Seel <br />Notary Public • State of Indians <br />St Joseph County <br />My Commission Expires Oct 22, 2022 <br />