Form ID

Publication date

Location of premises

Certificate

Renovation and Addition

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Mita Consulting
Address of Owner
420 York Street, London, ON
Name of Contractor
Flynnwood Construction
Address of Contractor
47 Tecumseh Ave., East, London, ON
Name of Certifier
Vito Campanale
Address of Certifier
420 York Street, London, ON N6B 1R1

Identification of Premises

RP 33R6 166 Part 1

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

420 York Street, London, ON N6B 1R1