Form ID

Publication date

Location of premises

Certificate

Construction of sidewalk and curb & gutter

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Town of Tillsonburg
Address of Owner
200 Broadway Street, 2nd Floor, Town Centre Mall, Tillsonbur
Name of Contractor
Autoform Contracting Ltd.
Address of Contractor
2039 Jetstream Road, London, ON N5V 4H7
Name of Certifier
Corporation of the Town of Tillsonburg
Address of Certifier
Operations Services, 10 Lisgar Avenue, Tillsonburg, ON N4G 5

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

Corporation of the Town of Tillsonburg, 200 Broadway Street, 2nd Floor, Town Centre Mall, Tillsonburg, ON N6G 5A7