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City of Santa ^ nla <br />k <br />r Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <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amendments (if any) are no longer in effect.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 />The agreement withY 11�i1 y <br />COTC Office Use Oniv <br />AA CITY CLERK <br />7'215.r:r-3�5 <br />N-2022-165 <br />No. was completed on I h-L and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />!AagreementsVormsVorm - agreement termination form_gddenrod.doc <br />Department:�t✓ <br />Phone/Ext.: <br />Signature: <br />Date:1�1 <br />�'� <br />