Form ID

Publication date

Location of premises

Certificate

Retail Renovation

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Beer Store
Address of Owner
5900 Explorer Drive, Mississauga, ON L4W 5L2
Name of Contractor
The Dae Group
Address of Contractor
11 Deverell Street, Whitby, ON L1R 1W4
Name of Certifier
Karl Olsen
Address of Certifier
5900 Explorer Drive, Mississauga, ON L4W 5L2

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

Same as above