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Stato of.l diana, County of <br />Marls Osler <br />Cxgame of Officer) <br />o;= Indiana Earth Inc. <br />(Contractor) <br />_ St Joseph T__ s s: <br />being duly svwrt4liathelsho is Clio President <br />hiving coutraetcd With City or South Bend <br />(Owner) <br />Yoflira7ishcerteiu[neiana@stano%rlaborbarollov�s; Outbuildin and Demolition Debris <br />(l]esexlptiort) <br />for aprojcctlmovvitas — Dreweryis Brewery--,---- <br />(Narno of Project) - <br />located at 1408 Elwood Ave. South Bend IN <br />and ownerlby Cityof South Bend _ <br />(owner) <br />and does hereby further state on the behalf: of the Aforementioned subcontractor/supplier: <br />(PARTIAL 14TA1VER) thatthoro is due firom the Contractor the Gum of <br />❑ receipt of which Ls hereby aclnowledged; or <br />(Title) <br />El the payment of which lies been promised as the sole consideration for this Affidavit and Final Waiver ofLlerimhich is given <br />solely with respect to said amount, and which waiver shall be offective only upon receipt of payment thereof by the <br />urideisigned; <br />(FIWAL. WAIVER that the final balance due ii-oin the contractor is tho Simi of <br />Twent r� i w - housand Three Hundred Ninety_One 39/100 _�� 22,391 _�9 <br />❑ receipt of whiah is hereby afowledged; or <br />she payment of which has been promised as tho solo consideration for 419a Affldavlt And Final Waiver of Lien which shall <br />become efFeetivo only upon receipt of such payment. <br />T'H13IEFORE, the undersigned waives and releases unto the ovrnor of slid premises, any and till lions or claims whrilsoevar <br />on the above -described property and inlprovemen'¢s thereon tm acco-twt of labor or material or both, furnished b the undersigned <br />thsrato, subject to limitations or conditions oxprwsed herein, if any; and further certified that rio other party has/ Any claim or right to a <br />lien on €recount of any work performed or material ftlmished to the undersigned for sal Wet, and Iliin � scope, of this Affidavit <br />and Waiver ofLlen. <br />(Firm) (Authorized Reprose Live) <br />STATE OF WDIANA ) <br />SS: <br />ST. JOSEPH COUNTY ) Mark Osier <br />Before me, the undersigned, a Notary Public, in and for said County and State, personally appeared <br />and acknowledged the executlon of the foregoing Affidavit acid Waiver of Lien. <br />IN WITNESS WHEREOF, I slave hcreunto subscribed my name and affixed my official seal on the 29th day of <br />October _ 202 4 — <br />Notary Public Signature — <br />My Commission Expires: <br />5/31 /2030 <br />Rosidingin St Joseph county, Indiana <br />Roxan_ne_Laurene Alford <br />Notary Public Name <br />�R- <br />;:" .,, ROXANNE LAUREN'r. ALFORD <br />�e;%, Notary Public, State of Indiana <br />° r s St. Joseph County <br />_' SEAL; 4 _Commission Numler NP0741524 <br />' r • ••',P My Commission Expires <br />