Form ID

Publication date

Location of premises

Certificate

County Road No. 12, Hamlet of Forest Mills, Contract No. 02-06.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lennox & Addington.
Address of Owner
97 Thomas St E., Postal Bag 1000, Napanee, Ontario K7R 3S9.
Name of Contractor
Fitzgibbon Construction Ltd.
Address of Contractor
51 Parks Drive, Belleville, Ont. K8N 4Z5.
Name of Certifier
G.D. Jewell Engineering Inc.
Address of Certifier
R.R. #7, Hwy. 62, Belleville, Ont. K8N 4Z7.

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

County of Lennox & Addington.