Form ID

Publication date

Location of premises

Certificate

Addition to Heritage Club.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Heritage Village Vineland Inc.
Address of Owner
4100 John Charles Blvd., Vineland, L0R 2C0.
Name of Contractor
Vace Construction.
Address of Contractor
As Above.
Name of Certifier
Archie Malcolm.
Address of Certifier
As Above.

Identification of Premises

As Above.

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

As Above.