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City of Santa ' na <br />t Clerk of the Cowicil <br />AGREEMENT TERMINATION FORM "J.1 <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amendments (if any) are no longer in effect.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. <br />Is the agreement(s) 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 />COTC Office Use Only <br />OF THE COUNCIL <br />R 2123 P0:26 <br />The agreement with LOz ANHVLfS SMSA LINITIM 10A1ZTNEIZ3k11P 011131IR WV41OnI <br />Wll(arss <br />No. A - 2 W - 04l 11 was completed on 31 07L and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />ragreementslfarmslfomr - agreement teaninatlon form_goldenrad.doc <br />Department: 1 NA -VFq. t(i(i, <br />Phone/Ext.: Lila) U4}-"3 <br />Signature: <br />Date: ovjej. 1022 <br />