Form ID

Publication date

Location of premises

Certificate

First Avenue Reconstruction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Town of Shelburne
Address of Owner
203 Main St. East, Box 69
Name of Contractor
Nelson Arnold Construction
Address of Contractor
R.R. #2, Shelburne, ON L0N 1S6
Name of Certifier
R.J. Burnside & Associates Ltd.
Address of Certifier
15 Townline, Orangeville, ON L9W 3R4

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

Town of Shelburne, 203 Main St. East, Box 69, L0N 1S0