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171045 <br />WAIVER AND FINAL RELEASE <br />The undersigned lienor, in consideration of the final payment in the amount of $10.00 hereby <br />waives and releases its lien right to claim a lien for labor services, or materials furnished to <br />TIMOTHY ROSE CONTRACTING INC. to the following described property: <br />CR 512 EASTBOUND RESURFACING <br />FELLSMERE, FLORIDA <br />Dated on: 3/12/18 <br />SIBONEY CONTRATINC CO. & <br />SIBONEY AGGREGATES, INC. <br />By: <br />G. Ortega — A/R- Coll. <br />State of Florida <br />County of Palm Beach <br />Acknowledged before me this March 12, 2018 by G. Ortega and on behalf of Siboney <br />Contractinp_ Co. & Siboney Aggregates Inc. and who is personally known to me. <br />Notary Public <br />Notary Seal/Commission Expires <br />aq.KGs`µ= MYCOMMISSION #FlEF237030 <br />eXt IRIS: September 30.2019 <br />Bonded Thru Nolary Pubfic UnderYAM <br />Note: This is a statutory form prescribed by Section 793.20, Florida Statutes (1996). Effective October 1, <br />1996, a person may not require a lienor to furnish a waiver or release of lien that is different from the <br />statutory form. <br />48 <br />