CLA-5-E (2014/03)

FORM 5 DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT

Construction Lien Act

(name of supplier)

a supplier of services or materials to an improvement being made to:

(address of premises)

declares that:

1. The following services or materials were supplied:(description of services or materials)

2. These services or materials were supplied under a contract (or subcontract) with(name of payer)

dated the day of ,20 .

3. The last supply of services or materials made by the supplier to the improvement under contract (or subcontract) was

made on(date of last supply)

4. No further services or materials will be supplied under the contract (or subcontract).

Declared before me at the

of in the

of(supplier)

on the day of ,20

A Commissioner, etc.

FORM 5 DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT Construction Lien Act�

CLA-5-E (2014/03)

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CLA-5-E (2014/03)

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FORM 5 DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT Construction Lien Act

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FORM 5

DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT

Construction Lien Act

a supplier of services or materials to an improvement being made to:

declares that:

1.         The following services or materials were supplied:

2.         These services or materials were supplied under a contract (or subcontract) with

.

3.         The last supply of services or materials made by the supplier to the improvement under contract (or subcontract) was 

made on

4.         No further services or materials will be supplied under the contract (or subcontract).

FORM 5
DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT
 Construction Lien Act

FORM 5, 
DECLARATION OF LAST SUPPLY UNDER SUBSECTION 31 (5) OF THE ACT, Construction Lien Act

CurrentPageNumber: NumberofPages: Field 1: Field 2: Field 3: TextField1: supplier: address of premises: description of services or materials: name of payer: dated the: day of: 20: date of last supply: Declared before me at the: of: in the: on the: day of: A Commissioner, etc.: Save Form: Print Form: Clear Form: