Form ID

Publication date

Location of premises

Certificate

Cold Recycle #291041 - 2005 Oxford Road 8 and #291044 - 2005 Oxford Road 44

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Market Square (P.O. Box 397), Woodstock, ON N4S 7Y3
Name of Contractor
Lavis Contracting Co. Ltd.
Address of Contractor
R.R. #2, Clinton, ON N0M 1L0
Name of Certifier
Oxford County Pubic Works
Address of Certifier
Same as owner

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

as above