Form ID

Publication date

Location of premises

Certificate

Municipal Roads and Services

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Mr. Angelo D’Ippoliti
Address of Owner
2986 Lauzon Road
Name of Contractor
Smith Contracting
Address of Contractor
5255 County Rd. #42, Windsor, ON N8N 2M1
Name of Certifier
Hanna, Ghobrial & Spencer Ltd.
Address of Certifier
3100 Temple Drive, Windsor, ON

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

Essex County Registry Office