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City of Santa 1 a <br />..... ....... <br />1 Clerk of the Council tort office use only <br />AGREEMENT TERMINATION FORM <br />"015 JI - -"/ PM 3: 37 <br />Please complete this form when the attached agreement and all CITY OF c ANT., _ I_' >, <br />amendments (if any) are no longer in effect. 3. i i , I " <br />CLERK 0; i , <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 />No. N -2014 -047 was completed on J/ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: P0.2-or <br />Phone /Ext.: <br />Signature: 23\ C, t i"'y <br />Date: S-f I ! S- <br />Revised 10 -31 -12 <br />