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City of Santa An - <br />Clerk of the Cou r <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemeCC,,��t, nd all <br />amendments (if any) are no longer in effect. � T22 pFEI- d I'M 3: 39 <br />Note: If your agreement is grant related, please ensure that all grant retention requirement, [� <br />have been satisfied prior to signing the termination form.T Y OF SA N TA A NA <br />Is the agreement(s) a permanent record? Yes _ No CLE"A U� COUNCIL <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 />'7 <br />No. —2 0 � -7 -IS Zwas completed on <br />(List all amendments. Use space below if needed.) <br />Revise; 10-I8-16 <br />�J <br />31 d and final payment has been made. <br />Department: <br />:T <br />Phone/Ext.: j,ZjZ—I <br />Signature: SA-J(2-kA� <br />Date: � �� <br />