Declaration of Last Supply

Form ID

F7-21901

Publication date

2021-05-18

Certificate

DOMINION FORMING INC.

A supplier of services or materials to an improvement being made to:

75 CANTERBURY PLACE TORONTO, ONTARIO

declares that:

1. The following services or materials were supplied:

CONCRETE FORMWORK

2. These services or materials were supplied under a contract (or subcontract) with:

CHURCHILL THREE PARTNERSHIP

dated the

January 31, 2018

3. The last supply of services or materials made by the supplier to the improvement under contract (or subcontract) was made on:

May 10, 2021

4. No further services or materials will be supplied under the contract (or subcontract).

Declared before me at the:

City of

WOODBRIDGE

on the

13th day of May, 2021

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