Form ID

Publication date

Location of premises

Certificate

Four Storey Sixty-Five Suite Hotel

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1485563 Ontario Ltd. c/o Signature Carleton Inc.
Address of Owner
85 Scarsdale Rd., Suite 306, Toronto, ON M3B 2R2
Name of Contractor
Signature Carleton Inc.
Address of Contractor
85 Scarsdale Rd., Suite 306, Toronto, ON M3B 2R2
Name of Certifier
Ian S. Malcolm Architect
Address of Certifier
126 Wellington St. West, Suite 207, Barrie, ON L4N BJ6

Identification of Premises

2937 Sherwood Heights Drive

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

Signature Carleton Inc.