Laserfiche WebLink
City of Santa to 1�0� <br />Clerk of the Council aj <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. ` I <br />Is the agreements) 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 <br />COTC Office Use Only <br />ANA CITY CLERK <br />I4123 Apra 1:33 <br />''vv v <br />No. R - 2 01 g - ( l0 5 was completed o Z� and final payment has been made. <br />(List all amendments. Use space below if needed.) rA <br />Department: 1,1,/7T <br />Phone/Ext.: ((/' 1 1/ <br />Signature: <br />Date: <br />_N <br />Revised: 10-18-16 <br />