Form ID

Publication date

Location of premises

Certificate

Reconstruction of 11th Street, #99-T14.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Cornwall.
Address of Owner
1225 Cornwall St., Cornwall, ON.
Name of Contractor
Cornwall Gravel Co. Ltd.
Address of Contractor
390 11th St. W., Cornwall, ON.
Name of Certifier
Norm Levac.
Address of Certifier
As above.

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

City of Cornwall, Address as Owner.