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Final Waiver of Lien <br />State of Indiana, County of St. Joseph SS: <br />Michael Jackson being duly sworn that he/she is the Controller <br />(Name of Officer) <br />(Title) <br />of Slatile Roofing and Sheet Metal Co. Inhavingcontractedwith City of South Bend <br />(Contractor) (Owner) <br />to furnish certain materials and/or labor as follows; Roofing and Sheet Metal <br />{Description) <br />for a project known as Mar_ -Main Apartments <br />(Name of Project) <br />located at 125 W. Marion South Bend, IN 46601 <br />and owned by City of South Bend <br />(Owner) <br />and does hereby fiu•ther state on the behalf ofthe 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 />Twenty Four Thousand Two Hundred Three Dollars and 10/100 24;203.1 <br />❑ receipt of which is hereby aoknowledged; 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 thereon an account of labor or material or both, Banished b the undersigned <br />thereto, subject to limitations or conditions expressed herein, if any; and farther certified that no other party has any claim or right to a <br />Tien on account of any work performed or material Banished to the undersigned for said project, thin the scope of this Affidavit <br />and Waiver ofLien. <br />Slatile Roofing and Sheet Metal Co. Inc. By <br />(Firm) (Auth zed Representative) <br />STATE OF MIANA ) <br />SS: <br />ST, JOSEPH COUNTY } <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared <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 21 st day of <br />December 200< 23 <br />,.SPRY P Ue �, Notary b Signature r <br />Ivey Commission Expires: �!U La�/26 LLB 0 . ' <br />�)� Amy Marquez <br />Residing in % County, Notary Public Name <br />OF <br />