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..6City of Santa p a <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amendments (if any) are no longer in effect. <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 />rarrlr � <br />COTC Office Use Only <br />0 FbA <br />No. <br />A ,?o,3 was completed on WaCtI 5- and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department: <br />Phone/Ext.:' <br />Signature:l01)i �%/s�(1 <br />110 <br />` jm <br />Date: ll it <br />Revised 08-23-10 <br />G 20[(;7 <br />