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City of Santa i - :i <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amendments (if any) are no longer in effect.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 />- C 2Ql <br />The agreement with lim Memorial Haspitq( ptrsbyierigh <br />No. N-2015-071 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: A �-V'V <br />Phone/Ext.: !Z�L' <br />Signature: Z -):k t -k Q.t azp <br />Date: 'A as \,i 0 <br />Revised 08-23-10 <br />