Form ID

Publication date

Location of premises

Certificate

MI-046, Park Street Extension - St. Clements, Ont.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Lorentz Holdings Inc.
Address of Owner
R.R. #1, St. Clements, ON N0B 2M0.
Name of Contractor
J.G. Goetz Construction Ltd.
Address of Contractor
PO Box 635, 400 Elizabeth St., Guelph, ON N1H 6L3.
Name of Certifier
Muirtec Incorporated - D.W. Lappage.
Address of Certifier
312 St. Anne Ave., St. Agatha, ON N0B 2L0.

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

Muirtec Incorporated - St. Agatha.