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City of Santa Ar , ci av1 <br /> ' 1- Clerk of the Coun_., coi c Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form when the attached agreement and all � (� `� 12 <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related,please ensure that all grant retention requirements `'L�,;„ F ;` <br /> have been satisfied prior to signing the termination form. CITY o' ��` 1 A �.�' <br /> CLIRMI OF OO� ,s,: <br /> b"s I 1,11 1`I�.� <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. • <br /> • <br /> • <br /> /� <br /> The agreement with _ i2 .- /Jt 01416'%/9/.1% "0 'a/ <br /> No. N-2016-051 was completed on 7//Sii L{ and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: \ k r <br /> Phone/Ext.: : 1-_S� <br /> Signature: J�c_OvGtiC-L,'F,U 0s.,Th <br /> Date: C1 6,-YI 1 ti <br /> Revised:01-07-16 <br />