HomeMy WebLinkAboutSmock Fansler Corp-Affidavit & Waiver of Lien AFFIDAVIT AND WAIVER OF LIEN
[ ] Final [X] Partial [X] Payment to Follow
State of Indiana
County of Marion
T.M. Fansler , being duly sworn states that he is the CEO of SMOCK FANSLER CORP.
having contracted with: Carmel Redevelopment Commission to furnish certain labor, materials,
and/or services as follows: Misc. Construction for a project known as: SFC#11-005 Carmel P. 73
Fountain located at Carmel,IN and does hereby state on behalf of the aforementioned contractor:
(PARTIAL WAIVER)that there is due from the owner the sum of: ($9,530.10)
Nine Thousand Five Hundred Thirty Dollars and 10/100
[ ] receipt of which is hereby acknowledged;or
[X] the payment of which has been promised as the sole corsideration of this Affidavit and Partial Waiver of
Lien which is given solely with respect to said amount,and which waiver shall be effective only upon
receipt of payment thereof by the undersigned;
(FINAL WAIVER)that the final balance due from the owner is the sum of($0.00)
[ ] receipt of which is hereby acknowledged;or
[ ] the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of
Lien which shall become effective upon receipt ofsuch payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or
claim whatsoever on the above-described property and improvements thereon on account of Labor,
Materials, and/or Services, furnished by the undersigned thereto, subject to limitations or conditions
expressed herein, if any; and further certifies that no other party has any claim or right to a lien on
account of any work performed, materials, or services furnished to the undersigned for said project, and
within the scope of this affidavit and waiver. ,f /J
SMOCK FANSLER CORP. By e/��'�� " Title CEO
T.M. Fansler
V C f
WITNESS MY HAND AND NOTARIAL SEAL,this 19th day of May ,201E
r` ! 71 !
Melissa J Bishop Notar}'Public .
My commission expires November 30. 2016 Residing in Morgan County