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City of Santa ? a <br /> ♦1 <br /> eta r 1 Clerk of the Council COTC Office Use Only <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 amendments (if any) are no longer in effect.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 <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 i'!N4 <br /> S‘MitetrAtel4 • <br /> No. .'`� _ �� ? 66 7 was completed on 7(�c /(7 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> /47 2O0 eQ , Department: Nill <br /> fI A, f squat, Phone/Ext.:ark <br /> 2` <br /> Signature: <br /> 71/' �AOCf� 4725-S�Q� ✓ Date: ! (3/r7 <br /> Revised: 10-13-10 /9 r.�//): — /O <br />