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Final Waiver of Lien <br />State of Indiana, County of r\ SS: La f L L LN /� being duly sworn that he/she is the _ 1 eS� C� n I <br />L <br />(Name of Officer) (Title) <br />of TCtA"Ar'r' C—CLA� Tn�. having contracted with City of South Bend <br />(Contractor) (owner) <br />to furnish certain materials and/or labor as follows; <br />for a project known as -T h f -e f- <br />,_)res <br />located at 6 G CC) l C ,�,l_dx�in fStr 1 I� <br />and owned by City of South Bend <br />_._._ (owner) <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 sum of <br />Dollars ($ ) <br />❑ receipt of which is hereby acluiowledged; 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 payment thereof by the <br />undersigned; <br />FINAL WAIVER) that the final balance due from 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 Affidavit and Final Waiver of Lien which shall <br />become effective only uponreceipt 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 thereon an account of labor or material or both„ furnished b the undersigned <br />thereto, subj ect 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 pe of this Affidavit <br />and Waiver ofLien. P" ,, —' <br />Dy <br />utn (Autho 'zedRepres dative) <br />STATE OF 1NDIANA ) ) Wit U SlQ r, � (Q <br />SS: <br />ST. IOSEPH COUNTY ) <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared kxo-rL <br />and acknowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal on the S'7 day of <br />Notary Publie Signature <br />My Commission Expires: 3 1 (d 1?yZ� <br />Residing in 2-e h County, TryL ang\ Notary Public Name <br />Amanda Lynette Johnson <br />Notary Public Seal State of Indiana <br />St. Joseph County <br />