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City of Santa is <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Off -ice Use Only <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amendments (if any) are no longer in effect.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 <br />No. A - Cam' }3-049 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: 5j ZI 11V <br />Revised 08 23-10 <br />