Form ID

Publication date

Location of premises

Certificate

2002 Hammarskjold Grounds Program

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Lakehead District School Board
Address of Owner
525 Hartland Street, Thunder Bay, ON P7B 2E2
Name of Contractor
The Gravel Doctor
Address of Contractor
R.R. #1, 1541 Rosslyn Rd., Thunder Bay, ON P7C 4T9
Name of Certifier
Kelly Russell, KGS Group
Address of Certifier
560 Squior Place, Thunder Bay, ON

Identification of Premises

Con. A Pt. Lot 4 Deed 6369 Irreg.

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

Cheadle Johnson Shanks MacIvor, Attention