Form ID

Publication date

Location of premises

Certificate

Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Whitchurch-Stouffville
Address of Owner
St. Johns Sideroad
Name of Contractor
Miller Paving
Address of Contractor
PO Box 4080, Markham, ON
Name of Certifier
Mr. Gordon Haggerty
Address of Certifier
37 Sandiford Drive, Stouffville, ON

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

Town of Whitchurch-Stouffville, 37 Sandiford Drive, Stouffville, Ontario