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City of Santa. .,ja <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amendments (if any) are no longer in effect. #_a <br />r)A <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-2520 if you have any questions. <br />The agreement with l� l <br />No. �/lJ1J�1/ t// `1b),as completed on f/^PSV and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: pol <br />Phone/Ext.: 10 1 Z' <br />Signature: <br />Date: i z ce ( 1 <br />Revised 0412-10 <br />