Form ID

Publication date

Location of premises

Certificate

Renovation Building / Fixture

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Loblaws Inc.
Address of Owner
1 Presidents Choice Circle
Name of Contractor
Re-Con Retail Construction Inc.
Address of Contractor
1472 Thornton Rd North, Unit #4, Oshawa, ON L1H 7K4

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

90 C-Line, Orangeville, ON - Jim & Lee-Anne's No Frills