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City of Santf- 4na <br />Clerk of the C;jjncil <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amendments (if any) are no longer in effect.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 -6520 if you have any questions. <br />The agreement with <br />COTC Office Use Only <br />ITS' 0 F. S N, e ! Y, <br />C Lt Ri i 0 <br />No. y0(I!-?::� was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone /Ext.: Sa <br />Signature: � Q-A,) c, QAA-iy K <br />Date: 9111 SA \% <br />Revised 08 -23 -10 <br />