Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Village of Burk's Falls
Address of Owner
172 Ontario Street, Box 160, Burk's Falls, ON P0A 1C0
Name of Contractor
Fowler Construction Company Limited
Address of Contractor
1206 Rosewarne Drive, PO Box 630, Bracebridge, ON P1L 1T9
Name of Certifier
R.V. Anderson Associates Limited
Address of Certifier
436 Westmount Avenue, Unit 6, Sudbury, ON P3L 1L5

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

The Clerk, Village of Burk's Falls, 172 Ontario Street, Box 160, Burk's Falls, ON P0A 1C0