Form ID

Publication date

Location of premises

Certificate

New Elevator, Handicap Washroom

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
St. John’s United Church
Address of Owner
123, 2nd Ave. East, Chesley, ON N0G 1L0
Name of Contractor
Allen-Hastings Limited
Address of Contractor
28 Birch Road, R.R. #1, Miller Lake, ON N0H 1Z0
Name of Certifier
Paul Dawson Architect
Address of Certifier
PO Box 278, Flesherton, ON N0C 1E0

Identification of Premises

St. John’s United Church, 123, 2nd Ave. East, Chesley, ON N0G 1L0

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

Land Registry Office, 203 Cayley Street, Walkerton, ON N0G 2V0
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