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.
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