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�Mly <br />Clerk of the Council core Office use Only <br />AGREEMENT TERMINATION FORM <br />C, ?0 <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amendments (if any) are no longer in effect.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. Iii 31 AN 1I; <br />01TY OF . <br />Return form to the Clerk of the Council Office (M-30). �Q����.3�l <br />Call 647-1520 if you have any questions. CLERK OF cOUN {i <br />The agreement with opine [guy* Ot4ilej "rid( Wtn & Uu kwAm <br />No. A— /X; 1V — 0 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />-1 w and final payment has been made. <br />Department:r!-e <br />Phone/Ext.: y l E <br />Signature: <br />Date: ilb)g� <br />