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City of Santa Ta I 1 corc office use only <br />Clerk of the Council <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amendments (if any) are no longer in effect.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!LERK OF T04E COW' sL <br />AL 26122 Pw4:27 <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 />No. p►-2021 p4' was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />A laa Department:C�1`i <br />/y _ .L n � C6 , l c� Phone/Ext.: rl> pSZ <br />Signature: 4 <br />01 <br />`��� Date: �/3lla�- <br />J x Ge <br />I:lagreementslrorm5form a3 e rmmeficn form__goltlenmd �icc i �/`, /,�(r qAr � p/ /_ <br />