Form ID

Publication date

Location of premises

Certificate

Contract No. 296808-2003 the construction of watermain and appurtenances in the Community of Lakeside in the Township of Zorra

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford
Address of Owner
415 Hunter St., (P.O. Box 397) Woodstock, ON N4S 4G5 (N4S 7Y
Name of Contractor
Pachecos Contractors Ltd.
Address of Contractor
4192 Perkins Road, London, ON N6L 1C2
Name of Certifier
Douglas Ellis, P. Eng.
Address of Certifier
Same as owner

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

As Above