Form ID

Publication date

Location of premises

Certificate

Interior Fixturing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Signature Centre Ltd.
Address of Owner
225 Metcalfe St., Ottawa, ON K2P 1P9
Name of Contractor
Terlin Construction
Address of Contractor
6961 McKeown Dr., Greely, ON K4P 1A2
Name of Certifier
The Beer Store
Address of Certifier
5900 Explorer Drive, Mississauga, ON L4W 5L2

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

225 Metcalf St., Ottawa, ON K2P 1P9/c.c. The Beer Store