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2-0tI <br />City of Santa ` -,a ✓ <br />Clerk of the Cout,cil <br />AGREEMENT TERMINATION FORM ------ <br />COTpC office Use Only <br />inti fiim_— <br />Please complete this form when the attached SANTAITIY OF <br />amendments (if any) are no longer in effect. I --- <br />CLERK QF pr 1, <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any <br />questions. <br />The agreement with <br />No. VxH -10d, was completed on <br />(List all amendments. Use space below if needed.) <br />Rz <br />— 14-19Q1 -135 (core, <br />-+ h-2004-I5g <br />Revised 08-23-10 <br />and final payment has been made. <br />Department: Tl/5./ k <br />Phone/Ext.: <br />Signature: <br />Date: <br />