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City of Santa A -1 <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <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amendments (if any) are no longer in effect.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 647-1520 if you have any questions. <br />The agreement with <br />C 2©1�' <br />Cr'T 23 ail <br />Y �', SA PT. <br />N-2015-167 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: i? ezQ�,A <br />Phone/Ext.: <br />Signature: � i It G CkO <br />Date: INA I - <br />Revised 10-31-12 <br />