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City of Santa - is <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC office use oniv <br />c:z j \ j)X CLERK OF THE COUNCIL <br />JJ" t JINN 2723 Phi4:33 <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amendments (if any) are no longer in effect.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 <br />No. N-2023-002 was completed on <br />(List all amendments. Use space below if needed.) <br />i:WgreemenlsVorms\farm - agreement termination form_goldenrod.doc <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature:ll <br />Date: <br />