Form ID

Publication date

Location of premises

Certificate

Site Servicing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1223360 Ontario Ltd.
Address of Owner
2985 Dougall Ave., Windsor, ON N9E 1S1
Name of Contractor
M.R.
Name of Certifier
Dillon Consulting Limited
Address of Certifier
3200 Deziel Drive, Suite 608, Windsor, ON N8W 5K8

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

The Corporation of the City of Windsor, Attention