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City of Santa, a <br />er `� Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all - <br />amendments if an are no longer in effect. <br />1, <br />( Y) g ` l `M —ij <br />L-- - <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-� if you have any questions. <br />The agreement with <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />,W -t 4-am-i3C!o are(I) <br />+ A- �010-110 00 <br />4 k - aa:fi -ago (14) <br />and final payment has been made. <br />Department: C-bA <br />Phone/Ext.: S 3-79 <br />Signature: U(4 tom/ <br />Date: <br />Revised 0412-10 <br />