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0 City of Santa Ana <br />1� Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <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amendments (if any) are no longer in effect.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 v <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 />Use Only <br />- i-il= Gij C.L <br />32'21Pm :2e <br />N-2018-114 <br />No. was completed on �00 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: `PKCSA <br />Phone/Ext.: lQM <br />Signature: / a�z <br />Date: N- <br />Revised: 10-18-16 <br />