Form ID

Publication date

Location of premises

Certificate

Interior Store Renovations

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Beer Store
Address of Owner
5900 Explorer Drive, Mississauga, ON L4W 5L2
Name of Contractor
Walter’s General Contracting Ltd.
Address of Contractor
PO Box 173, Everett, ON L0M 1J0
Name of Certifier
The Beer Store
Address of Certifier
5900 Explorer Drive, Mississauga, ON

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

Same as above