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City of Santa P ^a <br />Clerk of the Coup.-il <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amendments (if any) are no longer in effect.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 <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 />City of Santa Ana <br />Clerk of the Council <br />The agreement with J 61 Q-0 4n tom' AEI Ql(C yS`n� 1(Y�t �QJYL �f�i� <br />No. was completed on 31 l and final payment has been made. <br />(List all amendments. Use space below ff needed.) J <br />fa�.- ao\-I-O�i -0 Department: Tp-C Ts iAV ^( <br />jar- 'Do-I-0S\ Phone/Ext.: <br />Signature: \G... ` k'rp-Ai` .- <br />Date: -7 1 ,--*g L�)'\ <br />Revised: 10-18-16 <br />