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City of Santa a <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM — <br />COTC Office Use Only <br />36 JIVII l 71 InI —s- 19 <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. CITY OF S,41 A f <br />la- tKlk fil- <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-V1R3?jP4 Z kA i GiaWjz <br />No. A X13 -0?4 (1c) was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: ftdx - t 7 t lZ <br />Phone/Ext.: 77 <br />Signature:/ <br />Date: <br />Revised 0&2370 <br />