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City of Santa <br />c2.01 <br />Clerk of the Council COTC Office Use Only <br />............. <br />AGREEMENT TERMINATION FORM <br />7414 AIN 29 JON 5- 14, <br />Please complete this form when the attached agreement and all T` <br />amendments (if any) are no longer in effect. F. { A ANA <br />OF VOUNCit <br />Return form to the Clerk of the Council fice (M -30). <br />Call 647 -6520 if you have any questions. % <br />The agreement with <br />pw No. N- 2012 -141 was completed on o 3 s i 3 and final payment has been made. <br />e (List all amendments. Use space below if needed) <br />Department: PW A, - s;0-4 rc ,s <br />Phone /Ext.: <br />Signature: <br />Date: f i 2 i h't <br />Revised 07 -25 -] 2 <br />