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City of Santa Ana <br />t Clerk of the Council core office u:� only <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amendments (if any) are no longer in effect. 279 VtC i <br />Note. If your agreement is grant related, please ensure that all grant retention requirement tT g-� <br />have been satisfied prior to signing the termination form. U UNT <br />Is the agreement(s) a permanent record? Yes No ul o COUNCIL <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. /T �S — �% I was completed on �FyS� and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.: <br />( 7/— O y Signature: <br />Date: <br />Revised: 10-13-16 <br />tlj <br />x�0�3 <br />