Form ID

Publication date

Location of premises

Certificate

Installation of Municipal Services in Silverbirch Subdivision Township of Glanbrook.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
603976 Ontario Ltd.
Address of Owner
c/o A.J. Clarke and Associates Ltd., 125-155 James Street So
Name of Contractor
991877 Ontario Ltd. (operating as O.B.N. Company).
Address of Contractor
899 Nebo Road, R.R. #2, Box 51, Hannon, ON L0R 1P0.
Name of Certifier
A.J. Irani, P.Eng.
Address of Certifier
125-155 James Street South, Hamilton, ON L9P 3A4.

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

603976 Ontario Ltd. Attn