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City of Santa "na <br />Clerk of the Co. ocil <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amendments (if any) are no longer in effect.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 f tr sr7 A�56r,r /�gy/ o,;" /Y- <br />COTC Office Use Only <br />No. 22711 172-eJ (tw) <br />/7 s completed on G "�G� and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />L) �! <br />Phone /Ext.:yys <br />Signature: <br />a' -- <br />Date: <br />Z3 a3 <br />Revised 08 -23 -10 <br />