Form ID

Publication date

Location of premises

Certificate

Prepare/Grade and Do Site Services/Install Water Chamber

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Banas Stone Properties
Address of Owner
8144 King St., Bolton, ON L7E 0T8
Name of Contractor
Sierra Excavating Enterprises Inc.
Address of Contractor
82 Healey Rd., Bolton, ON L7E 5A7

Identification of Premises

8144 King St., Bolton, Ontario L7E 0T8

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

8144 King St., Bolton, Ontario L7E 0T8