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City of Santa i a <br />j 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amendments (if any) are no longer in effect.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 -1520 if you have any questions. <br />The agreement with <br />N- 2015 -146 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />Revised 10.31 -12 <br />VMS <br />........- <br />COTC Office Use Only <br />MY n- <br />�Rf - <br />tllV /� and final payment has been made <br />Department: <br />Phone /Ext.: <br />Signature: 0 KW A k <br />Date: ) <br />