Form ID

Publication date

Location of premises

Certificate

Project 67551 Bridge Reconstruction Spittler Creek, Oxford County Road 13

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford.
Address of Owner
415 Hunter Street (P.O. Box 397), Woodstock, ON N4S 4G5 (N4S
Name of Contractor
KKN Builders Incorporated
Address of Contractor
R.R. #2, Dublin, ON N0K 1E0
Name of Certifier
Tony Decoo, C.E.T.
Address of Certifier
As owner

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

As above