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City of Santa Ana <br />i 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amendments (if any) are no longer in effect.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 />CLa=PK OF Tp COgiNC?� <br />Is the agreement(s) a permanent record? Yes No _ "sts� 9�1 `2 € Pm2:54 <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 n <br />A-2019-008 <br />No. _ was completed on �L{ and final payment has been made. <br />(List all amendments. Use space below if needed.) n <br />Department: d' <br />Phone/Ext.: <br />Signature: <br />Date: `7A27�20?�1 <br />Revised: 10-18-16 <br />