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City of Santa to <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amendments (if any) are no longer in effect.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 647 -6520 if you have any questions. <br />The agreement with <br />C 2(i►3 <br />COTC Office Use Only <br />- - - - -- a., ------------------------ <br />17 Ply, <br />OF <br />r n}- <br />No. N -2011 -065 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: ?",q V <br />Phone /Ext.:�' <br />E <br />Signature: r <br />Date: <br />Revised 0 8-23 -10 <br />