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0City of Santa Ana <br />a t �t Clerk of the Co :il �j 1` 1 \n O COTC Office Use Only <br />�;'N 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amendments (if any) are no longer in effect.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 />Is the agreement(s) a permanent record? Yes No SANTA ANA CITY CLERK <br />jAR 13123 Prt3:45 <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The Cj^raamanf with <br />�. <br />A-2019-096 <br />No. was completed oaq 17 0and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: 6 <br />Signature: ^� <br />Date: "I / 2 v <br />Revised'. 10-18 16 <br />