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City of Santa ' na <br />com ohic e Use Only <br />Clerk of the Coocil <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amendments (if any) are no longer in effect.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 />C;'Y of Santa Ana <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 />kJ 0 2 2621 <br />Is the agreement(s) a permanent record? Yes— No <br />Clerk of the Counc-ill <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 O"W\ vm-'c U(3'n&'UKff==a' � . <br />No. L7-0n-2-16 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10- 18-16 <br />