Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street (P.O. Box 1614), Woodstock, ON N4S 3G1
Name of Contractor
2228977 Ontario Inc. o/a RANN Maintenance
Address of Contractor
8066 Wellington Road 124, Guelph, ON N1H 6H7
Name of Certifier
Frank Gross, C. Tech
Address of Certifier
Same as Owner

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

as above