Form ID

Publication date

Location of premises

Certificate

Capulet Lane Re-Alignment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Drewlo Holdings Inc.
Address of Owner
R.R. 3, Komoka, ON N0L 1R0
Name of Contractor
969774 Ontario Ltd. o/a Elgin Construction
Address of Contractor
140 Burwell Road, St. Thomas, ON N5P 3R8
Name of Certifier
Development Engineering (London) Limited
Address of Certifier
361 Dufferin Ave., London, ON N6R 1Z5

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

Addresses as above