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City of Santa Ana <br />Clerk of the Council COTC OHfce Use <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all �ir9 JIJL 19 P' 3.. 09 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements FLY K F OU CIL <br />have been satisfied prior to signing the termination form. ��RK OF ���NC�( <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 with <br />No. N-2018-076 was completed on I and final payment has been made. <br />(List all amendments. Use space below if needed.) p ryc� <br />Department: P �'�A <br />Phone/Ext.:J�S 4- n <br />Signature: `��g � C� `�Q )"Qkn <br />Date: ssdi4 ky <br />Revised: 10-18-16 <br />