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City of Santa Ana <br />Clerk of the Council cart Office use only <br />ti <br />AGREEMENT TERMINATION FORM Z'0 <br />Please complete this form in its entirety when the attached agreementgnd a;i <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amendments (if any) are no longer in effect.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 />The an—nman+wi+h 4 uJoLic <br />A-2019-094-06A <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />and final payment has been made. <br />