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Final Waiver of Lien <br />State of Indiana, County of �7 1 / _ SS: <br />( t' , being duly sworn that he he is the <br />T (blame of fficer) (Tide) <br />of lieml 11 �f)t rLk2►�ic25,/h <br />(Contractor) <br />having cantracted with <br />to furnish certain materlais and/or labor as follows; �Y Q WNLE <br />(Description) <br />for a project lazown as <br />located at <br />and owned by <br />of Project) <br />(Owner) <br />and does hereby further state ou the behalf of the aforementioned subcontractor/supplier: <br />(PARTIAL WAIVBR) that thew is due from the Contractor the sum of <br />❑ receipt of which i:s hexeby aciatowledged; or <br />(�Wn�1') <br />❑ t}te payment of which has been promised as the sole consideration. for this Ai�davit and FizlaI 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 WAIV)✓R that the final balance due frown the contracto is the sum of <br />i t�..��c�►_ u.sn,no! �D hun(ik�rfi,— �F,r vr►. � 5zl►oo ($ oZ'�-, a4.�. 5Z <br />❑ receipt of which is hereby acknowledged; or <br />Mize payment of which has been promised as the sole consideration forthis Affidavit and Final Waiver of Lieu which shall <br />become effective only upon receipt of such payment. <br />Tli6liEFORB, the undersigned waives and releases unto the Owner of said premises, any and all liens or claims whatsoever <br />on the above-desczibed property and improvements 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 fhrther 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 saidprojec , and withQthe sgope of,bas Affidavit <br />and Waiver of Lien r—®� // <br />STATB OF lNDitANA ) � - <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 aclatowledged the execution of the foregoing Affidavit and Waiver of Lien. <br />IN WITN SS WHMOF, I have hereunto subscribed my name and affixed my official seal on theOM LN <br />My Commission Expires: � �, � �?� �D <br />'Residing in county, � fy <br />N Public signature <br />RM IF <br />. A day of <br />UA <br />COMMISSION NO, 710399 <br />