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City of Santa . +a <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />AW5 , f.v; <br />Please complete this form when the attached agreement and II <br />amendments (if any) are no longer in effect. dry op � h <br />�ai'e e=` PE: <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />No. ) J-zouz— (i';f. f__)A was completed on <br />(List all amendments. Use space below if needed.) <br />Revised 08-23-10 <br />COTC Office Use Only <br />�: ?2 <br />)Z 31 Zm3 and final payment has been made. <br />Department: P160 <br />Phone/Ext.: X % / <br />Signature: <br />Date: <br />