Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
100 Mountain Road Limited
Address of Owner
31 Roxton Road, Toronto, ON M6J 2Y3
Name of Contractor
Ted Gibson Contracting
Address of Contractor
154 Brophy's Lane, Blue Mountains, ON L9Y 0K3
Name of Certifier
Tatham Engineering Limited
Address of Certifier
115 Sandford Fleming Drive, Unit 200, Collingwood, ON L9Y 5A6

Identification of Premises

Concession 10, Part of Lot 44, Plan 51R 6436 Part 2 Town of Collingwood, County of Simcoe

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

100 Mountain Road Limited