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City of Santa Ar -q _. <br />Clerk of the Coun <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. M11 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. �T ITYF <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. N-2016-051 was completed on <br />(list all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />C- aL�✓ <br />6&6 Office Use Only _ <br />25 RM 3z t 2 <br />S kic5 is=; 3$iNt; <br />£i F J <br />Sh LP and final payment has been made. <br />Department:- <br />Phone/Ext.: J�3.SZ+ <br />Signature:-=�93rct�>tGv� <br />Date: 9bsl YLp <br />