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4D. <br />City of Santa A <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and Xf!Q MN 24 <br />amendments (if any) are no longer in effect. rr yy <br />Note: If your agreement is grant related, please ensure that all grant retention requK q(itSO FA have been satisfied prior to signing the termination form. �l Cttf <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 />No. N o 7-jD14p - 1'bO was completed on foI?jmj2eV <br />(List all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />COTC Office Use <br />Department: C�r>iia <br />Phone/Ext.: X 2,t19 <br />Signature: O j=( <br />Date: [ zot r <br />