Form ID

Publication date

Location of premises

Certificate

Contract No.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as represented by the Minister of Transportation
Address of Owner
Ministry of Transportation, Bag 5000, Cochrane, ON P0L 1C0
Name of Contractor
M.L.R. Renovations
Address of Contractor
PO Box 2430, Cochrane, ON P0L 1C0

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

Director, Legal Services Branch, 1st Floor, West Tower, 1201 Wilson Avenue, Downsview, ON M3N 1J8