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City of Santa A <br />Clerk of the Coun�l <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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />The agreement with �L a,2,2 r�a� <br />N-2015-169 <br />No. was completed on j ( Ig I&) ti -7) and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: r ZV SA <br />Phone/Ext.: gQWA <br />Signature: (�/'�; p/�j' 2�/ <br />Date: "Il)a` on <br />Revised 10-31-12 <br />