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City of Santa . la <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />C 2001- <br />Use Only <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect.'" Ir <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 <br />No. <br />``"1 I "I ✓"1 ct1P2 was completed on 7� and final payment has been made. <br />�y (List all amendments. Use space below if needed.) <br />Department: 1j�j�Ut1 �1 � r�p 191� taw' 1 <br />Phone/Ext.: <br />F4 7iJU3 I�lo �)p� Signature: <br />20p3 ZS��Id Date: <br />Revised 08-23-10 <br />