Form ID

Publication date

Location of premises

Certificate

Site Servicing.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1196819 Ontario Limited, c/o Mr. Jerry Kubinec.
Address of Owner
66 Oak Drive, Essex, Ont. N8M 3C5.
Name of Contractor
Sherway Contracting (Windsor) Ltd.
Address of Contractor
5390 Outer Drive, R.R. #1, Windsor, ON N9A 6J3
Name of Certifier
Dillon Consulting Limited.
Address of Certifier
3200 Deziel Drive, Suite 608, Windsor, Ont. N8W 5K8.

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

The Corporation of the Town of Kingsville, Attention