Form ID

Publication date

Location of premises

Certificate

Construction (Mean Poutine)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Mean Poutine (Rustin Jafari)
Address of Owner
5 Rossland Rd. E.
Name of Contractor
Paul Evangelatos
Address of Contractor
182 Nature Haven Cres, Pickering, ON L1X 0A5
Name of Certifier
Paul Evangelatos
Address of Certifier
182 Nature Haven Cres, Pickering, ON L1X 0A5

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

Rustin Jafari, 12 O'Shea Cres. Ajax, ON