Form ID

Publication date

Location of premises

Certificate

Site Servicing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Alba Holdings Ltd.
Address of Owner
1397 County Road 22, R.R. #3, Belle River, ON N0R 1A0
Name of Contractor
Sherway Contracting (Windsor) Ltd.
Address of Contractor
5390 Outer Drive, R.R. 1, Windsor, ON N9A 6J3
Name of Certifier
Dillon Consulting Limited
Address of Certifier
3200 Deziel Drive, Suite 608, Windsor, ON N8W 5K8

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

The Corporation of the Town of Lakeshore, Attention