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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 ail <br />amendments (if any) are no longer in effect. <br />Nate: 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 />The ann-P.m,wifh publ i(' V N om (hjp'lc y L") <br />COTC Office Use Only <br />,DC1 J ' <br />A-2019-094-06C <br />No. _ was completed on/-'�L29nd final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: , 7- � , �-;)'5L-----� <br />Signature: <br />Date: <br />Revised: 10-1 S-16 <br />