Form 6

Use this form for the publication of a Notice of Non Payment of Holdback under section 27.1 of the Act

Owner

	Name	Address
1

Description of the premises

Contractors

	Name of contractor	Address of Contractor
1
1

Address for service

(if known)

Amount Holdback *

The full amount of holdback

The portion of the amount of holdback

Date

Upload Certificate

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