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0 City of Santa A--t <br />-- — — <br />Clerk of the Com-ij core office use only <br />AGREEMENT TERMINATION FORM <br />1 I <br />Please complete this form in its entirety when the attached agreement and1aV Alr•r, 20 AN R. �9 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CI OF SH l; Icy MAiIL � <br />have been satisfied prior to signing the termination form. Or CO I A N <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 �,P� -A 6K- Ca <br />L <br />A-2018-135-23A l <br />No. _ was completed on _U� C and final payment has been made. <br />(Lisr all amenaments. use space below if needed.) <br />Department: cAA <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />