Form ID

Publication date

Location of premises

Certificate

Roof Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Zitia Properties
Address of Owner
105 Colborne Street West, Brantford
Name of Contractor
Paulsan Construction
Address of Contractor
16-20 Roy Blvd., Brantford, ON

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

2 Grand River Street, Paris, Ontario