Form ID

Publication date

Location of premises

Certificate

Site Servicing.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
2006235 Ontario Ltd., c/o Piroli Construction Inc.
Address of Owner
8 Shawnec Court, Leamington, Ont. N8H 5A8.
Name of Contractor
M.R.
Name of Certifier
Dillon Consulting Limited.
Address of Certifier
3200 Deziel Drive, Ste. 608, Windsor, Ont. N8W 5K8.

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

The Corporation of the Town of Lakeshore, Attn