Form ID

Publication date

Location of premises

Certificate

New EMS Station.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lambton.
Address of Owner
789 Broadway St., Wyoming, Ont.
Name of Contractor
Chamney Contracting Ltd.
Address of Contractor
125 Clarke Road, London, ON N5W 5W1
Name of Certifier
George Leehouts.
Address of Certifier
As Owner.

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

County of Lambton, Wyoming, Ontario.