Form ID

Publication date

Location of premises

Certificate

Erection of Mike’s Mart.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1235789 Ontario Ltd.
Address of Owner
136 Caribou Road, Toronto, ON M5M B3.
Name of Contractor
Sal-Dan Developments Ltd.
Address of Contractor
64 Industrial Park Cres., Sault Ste. Marie, ON P6B 5P2.
Name of Certifier
W.G. Hollingsworth, P.Eng.
Address of Certifier
39 Parkshore Drive, Sault Ste. Marie, ON.

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

Owner, Address as above.