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City of Santa, _,a <br />I' 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amendments (if any) are no longer in effect.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 (M30). <br />Call 647-6520 if you have any questions. <br />COTC Office Use Only <br />Ci Q' <br />r i <br />�ANA <br />The agreement with 1 F.f X---' I wa <br />�� (�),/� <br />No. �� s completed on 3 and final payment has been made. <br />(list all amendments. Use space below if needed.) p, a 2g04• 133 C'I, G®re) Department: bA <br />4 A 2_00 - 133 k C z.$) <br />Phone/Ext.: <br />A'2Alf)-(b°.! Lei <br />R 2cll_ �Igol'2�) <br />Signature: <br />-- A-aol)-oo3 (u) <br />Date: <br />Revised 0&23-10 <br />