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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 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amendments (if any) are no longer in effect.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 <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 �1 c r! ^T)' .56ZL0716 N <br />A-2015-161-01 <br />No. _ was completed on <br />(List all amendments. Use space below it needed.) <br />Revised: 1 Q 18-16 <br />5 D and final payment has been made. <br />Department: l�� - L✓� �y�E <br />Phone/Ext.: <br />Signature: �� V C� `✓ <br />i <br />Date: <br />