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City of Santa ,a <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement an(GRY OF S "ANIAA A H A <br />amendments (if any) are no longer in effect. CLERK OF COU" `L:1 <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 />G 2tiS l�' <br />- ___`j <br />Ilse Only <br />No. N-2015-062 was completed on and final payment has been made. <br />(List alf amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.:— <br />Signature: <br />Date:[a <br />Revised 10.31-12 <br />