Form ID

Publication date

Location of premises

Certificate

Timmins West Mine Entrance

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Lake Shore Gold Corporation, Mr. Al Bussierre
Address of Owner
8215 Highway 101 West, Timmins, ON
Name of Contractor
Interpaving Ltd.
Address of Contractor
2385 Riverside Drive, Timmins, ON
Name of Certifier
GENIVAR
Address of Certifier
834 Mountjoy St. South, P.O. Box 120, Timmins, ON P4N 7C5

Office to which claim for lien must be given to preserve lien

Lake Shore Gold Corporation, 8215 Highway 101 West, Timmins, ON