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City of Santa A, <br />COTC Office Use Only <br />i Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemMARA161 Pry >,f. <br />amendments (if any) are no longer in effect. 3 <br />Note: If your agreement is grant related, please ensure that all grant retention requirern y D1 S 4 i <br />c <br />have been satisfied prior to signing the termination form.ER{ j r� �� <br />6 OU�dCIL <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 <br />N-2018-160 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below ff needed.) <br />Department: PRCsipt <br />Phone/Ext.: �gRlgq <br />Signature: <br />Date: 101,30liq <br />Revised: 10-18-16 <br />