Form ID

Publication date

Location of premises

Certificate

Proposed New Gate/Fence

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation
Address of Owner
Vice President, Project Management Branch, Ontario Realty Co
Name of Contractor
W.V. Wallans Contracting Ltd.
Address of Contractor
PO Box 40, Carrying Place, ON K0K 1L0
Name of Certifier
Mr. Dale Bush
Address of Certifier
161 Elgin Street, 5101, Ottawa, ON K2P 2K1

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

Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley St. West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 1N3