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City of Santa Aria <br />Clerk of the Cour <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amendments (if any) are no longer in effect.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 />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. <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 G-1 10 60,1 J q �2� t t �2 <br />KP 27 M - 17 <br />No. �J` „G f to was completed on G I 1i and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department: V }E <br />Phone/Ext.: <br />Signature: (a UkVaZ� <br />Date: jn <br />Revised: 01-07-16 <br />