Form ID

Publication date

Location of premises

Certificate

Municipal Roads and Services

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1339584 Ontario Limited
Address of Owner
RR#1, 485 Little Baseline Rd., N8W 5J6
Name of Contractor
M.R.
Name of Certifier
HGS Limited
Address of Certifier
3100 Temple Drive, Windsor, ON N8W 5J6

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

Essex County Registry Office
Print