Form ID

Publication date

Location of premises

Certificate

Site grading for Woodingford Lodge Woodstock and the New Woodstock General Hospital

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
Van Rooyen Earthmoving Ltd.
Address of Contractor
R.R. #4, Woodstock, ON N4S 7V8
Name of Certifier
Tony Decoo C.E.T.
Address of Certifier
Same as Owner

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

As above