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City of Santa Ana \� <br />Clerk of the Cot it <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amendments (if any) are no longer in effect.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 al 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 agreement with <br />A-2019-098 <br />No. <br />(List all amendments. <br />Revised: 10-18-16 <br />(/ (,iylSs(�``1/4p� lI L <br />was completed Ojw <br />Use space below if needed.) <br />Department: <br />Only <br />ANA CITY CLERK <br />13123 PM3=46 <br />and final payment has been made. <br />P <br />Phone/Ext.: <br />Signature: G/ <br />Date: <br />