Form ID

Publication date

Location of premises

Certificate

Site Servicing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1027458 Ontario Inc. c/o Coco Paving (1990) Inc.
Address of Owner
6725 South Service Road, R.R. #2, Windsor, ON N8N 2M1
Name of Contractor
Coco Paving (1990) Inc.
Address of Contractor
6725 South Service Road, R.R. #2, Windsor, ON N8N 2M1

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

The Corporation of the City of Windsor, Attention