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City of Santa A i <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM -- ----- <br />COTC Office Use Only <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with er :�Xs S(�S/a,.Av std <br />No. - IL�— VSS (4)was completed on /! and final payment has been made. <br />J\.L (List all amendments. Use space below if needed.) <br />* A -2013'10] (j) (or, Department: <br />Phone/Ext.: SDISZA <br />Signature: 42,A 3(L� l t hf <br />Date:ylj Ilei <br />Revised 05-23-10 <br />