Form ID

Publication date

Location of premises

Certificate

6th line Culvert Extension

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of Southgate
Address of Owner
RR #1, Dundalk, ON N0C 1B0
Name of Contractor
Maloney & Pepping Construction Limited
Address of Contractor
345 Douglas St., Stratford, ON N5A 5R4
Name of Certifier
R.J. Burnside & Associates
Address of Certifier
3 Ronell Crescent, Collingwood, ON L9Y 4J6

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

Township of Southgate