Form ID

Publication date

Location of premises

Certificate

Contract 296807-2003 the construction of the Water Treatment Facility in the community of Innerkip

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford
Address of Owner
21 Market Square (P.O. Box 397), Woodstock, ON N4S 5S1 (N4S
Name of Contractor
Stone Town Construction
Address of Contractor
25 Water Street North, Box 190 St. Marys, Ont. N4X 1B1
Name of Certifier
Douglas Ellis, P.Eng.
Address of Certifier
as owner

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

As above