Form ID

Publication date

Location of premises

Certificate

GMT 172/177 Body Shop Conveyors PO # 505823, 507294, 514462

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Cami Automotive Inc.
Address of Owner
300 Ingersoll Street, Ingersoll, ON N5C 4A6
Name of Contractor
Automatic Systems, Inc.
Address of Contractor
9230 E. 4th Street, Kansas City, MO 64133

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

300 Ingersoll Street, Ingersoll, ON N5C 4A6