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City of Santa a COTC Office Use Only <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />JJ <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amendments (if any) are no longer in effect.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. CLERIC O THE C3Uh(-:L <br />MRP > 23 PM2:23 <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-2022-301 V cancej, e-cl <br />No. <br />(List all amendments. <br />was Gec40eted on <br />Use space below if needed.) <br />hagreementslfcrmsVorm - agreement termination form_goldenrod.doc <br />wA <br />O 1 &1 2-oy3 arad tune! peas talacT�bee n nac . <br />Department: C, Dolt W �( f-Q( <br />Phone/Ext.: �C 1; 5 q5 11 <br />Signature:--vc-� <br />Date: /lot 2�2, <br />