Form A (Clause 2(1)(v) of The Builders’ Lien Act)
WRITTEN NOTICE OF LIEN
Name of lien claimant:
Address of lien claimant:
Address for service (if different from
above, otherwise leave blank):
Name of owner or person believed to
be owner:
Address of owner or person believed
to be owner:
Name of person for whom the
services or materials have been
provided:
Address of person for whom the
services or materials have been
provided:
Short description of services or
materials that have been provided:
Amount claimed in respect of $_____________
services or materials that have been
provided:
A description of the land (sufficient
for identification purposes):
Date (day/month/year) Signature
Form C.1 (Subsection 41(1.3) of The Builders’ Lien Act)
CERTIFICATE OF SUBSTANTIAL PERFORMANCE OF CONTRACT
This is to certify that the contract in the amount of $__________________________ in relation
to the following services or materials: (Give short description of services or materials provided.)
to the following improvement: (Give short description of improvement.)
to the following land:
Legal description or civic address of land:
is substantially performed.
CONTRACTOR:
I/We certify that the contract described above has been substantially performed.
Name of Contractor Authorized Signature
Address Date (day/month/year)
-2-
PAYMENT CERTIFIER: (if any)
I/We certify that we have examined and verified that the contract described above is substantially
performed.
Date (day/month/year) Signature of Payment Certifier
(If no payment certifier, the certificate must be signed by the owner.)
Signature of Owner
Name of Owner:
Address for Service:
Name of Payment Certifier (if any):
Address of Payment Certifier (if any):
Form C (Subsection 41(1.1) of The Builders’ Lien Act)
CERTIFICATE OF SUBSTANTIAL PERFORMANCE OF SUBCONTRACT
This is to certify that the subcontract in the amount of $__________________________ in
relation to the following services or materials: (Give short description of services or materials
provided.)
to the following improvement: (Give short description of improvement.)
to the following land:
Legal description or civic address of land:
is substantially performed.
SUBCONTRACTOR:
I/We certify that the subcontract described above has been substantially performed.
Name of Contractor Authorized Signature
Address Date (day/month/year)
PAYER ON THE SUBCONTRACT:
I/We certify that we have examined and verified that the subcontract described above has been
substantially pe