Form ID

Publication date

Location of premises

Certificate

Project No. R443-08 Stockpiled Screened Sand for Winter Sanding

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Town of Kirkland Lake
Address of Owner
#1 Dunfield Road, Postal Bag 1757, Kirkland Lake, ON P2N 3P4
Name of Contractor
Armand Souriol Trucking
Address of Contractor
P.O. Box 1323, Kirkland Lake, ON P2N 3P2
Name of Certifier
Owner
Address of Certifier
Same as Above

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

Owner's Address