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City of Santt4a <br />- Clerk of the Council i core of <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all niq <br />amendments (if any) are no longer in effect. P« f r, I' <br />Note If your agreement is grant related, please ensure that all grant retention requirementI P, <br />have been satisfied prior to signing the termination form. <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />No. /�—,)o 4— 3-V? was completed on <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 01-07-16 <br />and final <br />payment has been made. <br />