Form ID

Publication date

Location of premises

Certificate

Site servicing including driveways and sanitary sewers

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
RIC (Kash) Inc. c/o/ Romspen FC Homes
Address of Owner
162 Cumberland Street, Suite 300, Toronto, ON M5R 3N5
Name of Contractor
Hawk River Construction
Address of Contractor
82 Mallard Road, Haliburton, ON K0M 1S0
Name of Certifier
C.C. Tatham & Associates Ltd.
Address of Certifier
8 Barron Drive, Bracebridge, ON P1L 0A1

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

Owner