Form ID

Publication date

Location of premises

Certificate

Supply & Installation of Leach Tanks

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Porcupine Joint Venture - Dome Mine
Address of Owner
PO Box 70 - 1 Gold Mine Rd., South Porcupine, ON
Name of Contractor
1510610 Ontario Inc. o/a Central Welding & Iron Works
Address of Contractor
1811 Seymour Street, North Bay, ON P1B 8G4
Name of Certifier
Porcupine Joint Venture
Address of Certifier
PO Box 70 South Porcupine, ON P0N 1H0

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

Porcupine Joint Venture, PO Box 70 1 Gold Mine Road, South Porcupine, ON P0N 1H0