Form ID

Publication date

Location of premises

Certificate

Construction of a newly built home

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Adina Zak and Mark Zak
Address of Owner
207 Banner Lane, King City, ON L7B 1H2
Name of Contractor
Adina Zak and Mark Zak
Address of Contractor
207 Banner Lane, King City, ON L7B 1H2

Identification of Premises

PIN 03376 - 0174 LT, Lot 30, Plan 595 King

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

207 Banner Lane, King City, Ontario