Form ID

Publication date

Location of premises

Certificate

New Church Building

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
United Pentecostal Church of Brantford
Address of Owner
163 Brant Road, Highway 24 North, St. George, ON
Name of Contractor
United Pentecostal Church of Brantford
Address of Contractor
163 Brant Road, Highway 24 North, St. George, ON
Name of Certifier
Dwayne Budgell
Address of Certifier
1105 Rest Acres Road, Paris, ON N3L 3E3

Identification of Premises

Part Lot 13, Plan #2R-4147, Parts 3&4, 163 Brant Road, Hwy 24, St. George, ON

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

P.O. Box 28016, North Plaza Post Office, Brantford, ON N2R 7X5
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