Form ID

Publication date

Location of premises

Certificate

Dairy Queen Store at the above address

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Sam Awad
Address of Owner
210 Great Northern Rd Sault Ste. Marie, ON P6B 4Z4
Name of Contractor
GLT Construction INC
Address of Contractor
90 Annagem Blvd., Mississauga, ON L5T 2Y3
Name of Certifier
Cathy & DeeDee Int'l Corp., Sam Awad
Address of Certifier
210 Great Northern Rd Sault Ste. Marie, ON P6B 4Z4

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

Samih Awad