Form ID

Publication date

Location of premises

Certificate

Municipal Roads and Site Services

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
128761 Ontario Limited
Address of Owner
3199 Dougall Ave., Windsor, ON
Name of Contractor
M.R.
Name of Certifier
HGS Limited
Address of Certifier
3100 Temple Drive, Suite 100, Windsor, ON

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

Essex County Registry Office