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Final Waiver of Lien <br />State ofindiana, County of '�_ _ SS: <br />� <br />being duly sworn that he/she is the <br />1r.(me Naof t7ffleor) 4 <br />(Title) <br />of �'� 1 1 (\ . hsving contracted with Rm �j t <br />(Contractor) (Qwncr} <br />to famish certain materials andlor labor as follows: Wl ►J ` 1 V l �C� laY) U "al ) no Y k <br />for a project known as <br />located at <br />and owned by <br />tuanuip[tvn) ! . <br />-R�au_ <br />�i�< �YYI►n,n1�l.R1P ��� <br />and does hereby Author state on the behalf of the aforedmentioned subcontractor/supplier: <br />(PARTIAL WAiVlM that there is due 8tom the Contractor the sum of <br />Dollars $ <br />❑ receigt of whioh is hereby aoltnowlcdged; or <br />❑ tlto payment of which has been promised as the sole consideration for this Affidavit and final Waiver of LlerrwhLeh is given <br />solely will( respect to said amount, and which waiver shall be affective only upon receipt of payment thereof by the <br />undersigned; <br />-(FINAL WAIVi R) that the al balance due kom Pie contract r is the sum or <br />❑ receipt of which is here y acicrtowledr.ged; <br />the payment of which has been promised as the sole consideration for this Affidavit and Huai Waiver of Lien which shall <br />become effective only 11ponreccipt of such payment. <br />THRREFORE, the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever <br />on the above•dcscribed property and improvements thereon an account of labor or material or both, Aunished b the undersigned <br />lhemlo, suThlect 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 ihmished to the undersigned for said project, and within the scope of this Affidavit <br />and Waiver of Lletr. <br />{ 11y <br />STATE OF 1NDIANA um ) 711'11 <br />(Authorized Representative) <br />SS: <br />ST. JOSEPH COUNTY ) r r <br />Before me, the undersigned, a Notary Public, In and for said County and State, personally appeared r f _lj"� J <br />and acknowledged the executian of tho foregoing Affidavit and Waiver of Lion. <br />IN WITNESS VfMREOF, I have hereunto subscrlhed my narno and afOxed my official seal on the _ _ day of <br />Voli rV 1 20f! 2M3, <br />�. <br />otary iPtrblic Signature � - <br />my Commission aphos: 1 <br />Residing in xL County, . LJf�f�c�S,L--,�-. _ ....,�,i Ps►bIia��dt�ty <br />Dana Fisher <br />Notary Public Seal State of Indiana <br />St Joseph County <br />Commission Number NPO-1034e3 <br />My Commission Fxplfes O6i01i20025 <br />