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City of Santa ! a <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amendments (if any) are no longer in effect.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 />COTC Offii <br />".n <br />"A <br />Czolz <br />Use Only <br />The agreement with <br />1 / <br />N- 2010 - 076 -001 (3p) <br />No. was completed on (9(501(7- and final payment has been made. <br />ha.- (List -ali amendments -Use space below if needed.) <br />N - 2,010 - 0-lb COfC (3) Department: <br />Phone /Ext.: <br />Signature: <br />Date: <br />Revised 0 8-2 3-10 <br />