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City of Santa .R 1 <br />Clerk of the Council coTc offic............... Usenly <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement al'U'l ,,O —6 <br />amendments (if any) are no longer in effect. PH 4-- 21 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY <br />©r- SAhTA <br />have been satisfied prior to signing the termination form. C«R+', OF COLVLL <br />Is the agreement(s) a permanent record? Yes No <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 �0ej <br />No. N-2017-001 was completed on .' and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: VWr-A <br />Phone/Ext.: %ACA <br />Signature: %rLhj7. <br />Date: ��iZ iGY <br />Revised: 10-18-16 <br />