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City of Santa Ana <br />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amendments (if any) are no longer in effect.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 />�P <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. IJ c�, /7 — C) / was completed on <br />(List all amendments. Use space below it needed.) <br />Revised: 10-18-16 <br />D$1V <br />COTC Office Use Only <br />PjE ME MUNCII_ <br />123 12 _ P.Q:41 <br />�3/xt and final payment has been made. <br />Department: C ��/' 'd Vl (/6A <br />Phone/Ext.: / <br />Signature: )7�t Ca'fea <br />Date:: / g <br />