Form ID

Publication date

Location of premises

Certificate

Reconstruction on Oak Avenue, Paris

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Bant
Address of Owner
Hwy 53, Mount Vernon, P.O. Box 160, Burford, Ontario N0E 1A0
Name of Contractor
Robert M. Simon Construction Ltd.
Address of Contractor
R.R. #1, P.O. Box 973, Waterford, Ont. N0E 1Y0.
Name of Certifier
Totten Sims Hubicki Associates.
Address of Certifier
72 Victoria Street South, Suite202, Kitchener, Ontario N2G 4

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

County of Bant , Hwy 53, Mount Vernon, P.O. Box 160, Burford, Ontario N0E 1A0