Form ID

Publication date

Location of premises

Certificate

Bridge Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lambton
Address of Owner
789 Broadway Street, Wyoming, ON N0N 1T0
Name of Contractor
Facca Inc.
Address of Contractor
747 County Road 31, RR 1, Ruscom, ON N0R 1R0
Name of Certifier
B.M. Ross and Associates Limited
Address of Certifier
62 North Street, Goderich, ON N7A 2T4

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

County of Lambton, 789 Broadway Street, Wyoming, Ontario N0N 1T0