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City of Santa r.na COTC Office Use Only <br /> ;fir t Clerk of the Council <br /> :tw <br /> AGREEMENT TERMINATION FORM • <br /> Please complete this form in its entirety when the attached agreement and all <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements <br /> have been satisfied prior to signing the termination form. <br /> Is the agreement(s)a permanent record?Yes No <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. <br /> The agreement with C/7y O F /V 6Lt/P02T 6 E-ff-c,-/ <br /> No. Ai — Ito was completed on Ju,/G-- /8, Zar9 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: c.-TA a A N A a L . T 9?f. <br /> Phone/Ext.: 7(-{ - S'goo c' <br /> Signature: °" 2 S"�3 <br /> Date: C1L,/20 <br /> i:lagreements\formslform-agreement termination form_goldenrod.doc <br />