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City of Santa la <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M -30). <br />Call 647411111111111 if you have any questions. <br />65?o <br />The agreement With <br />No �� (� 41 °�� ! rla) was completed on <br />(List all amendments. Use space below if needed.) <br />p_;kooi -136 eort 0) <br />Revised 0412 -10 <br />fi(2 <br />l T r - T AP ANA <br />Only <br />�O C and final payment has been made. <br />Department: <br />Phone /Ext.: <br />r AJ <br />Signature: <br />Date: <br />