Form ID

Publication date

Location of premises

Certificate

Construction of severance servicing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Nina Mohan
Address of Owner
367 Shama Court
Name of Contractor
Holsgrove Trucking and Excavating Ltd.
Address of Contractor
3429 Princess St., Kingston, ON K7P 3A5.
Name of Certifier
J. Murray Josselyn P.Eng., Josselyn Engineering Inc.
Address of Certifier
633 Norris Court, Suite #3, Kingston, ON K7P 2R9

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

Corporation of the City of Kingston, 216 Ontario St., Kingston, Ontario