Form ID

Publication date

Location of premises

Certificate

Construct EMS Station

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lambton
Address of Owner
789 Broadway St., Wyoming, ON
Name of Contractor
CCL Contracting Ltd.
Address of Contractor
125 Clarke Rd., Unit 8, London, ON
Name of Certifier
George Leenhouts
Address of Certifier
Same as owner

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

County of Lambton