Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street (P.O. Box 1614), Woodstock, ON N4S 3G1
Name of Contractor
Northern Contracting & Maintenance (Sault) Ltd.
Address of Contractor
123 March St Suite 100, Sault Ste Marie, ON P6A 2Z5
Name of Certifier
Frank Gross, C. Tech Manager of Transportation and Waste Management Services, Oxford County
Address of Certifier
Same as Owner

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

as above