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City of Santa P C 2DII <br />Clerk of the Council Y <br />AGREEMENT TERMINATION FORM <br />......... ........... .........--....... ..........._----------- ._.......__....---- <br />COTC Office Use Only <br />L:1: w S i. t t ,;F <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. rf" <br />u�r <br />Return form to the Clerk of the Council Office (M-30). <br />The agreement with <br />f � ! - <br />No. /K DT/Q ` //3 was completed on O&f aQ;( and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: ]!2 NG 11- x 5401-� <br />Signature: <br />Date: <br />Revised 0412-10 <br />