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City of Santa Ana <br />r,,�!t Clerk of the Council corc office use Only <br />10 <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amendments (if any) are no longer in effect.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 OuLsGHt,I b W(Tff <br />No. A ';)L-0 g) -- 0 / 0 was completed on <br />(List all amendments. Use space below ff needed.) <br />Ra,secl 10-13-1 o <br />t Nb CUJ)-E/Z Ltil i?��oi2 T�.D <br />i <br />cT 3� U and final payment has been made. <br />Department: l�6tiR - �( <br />Phone/Ext.: AXSc;l3 <br />Signature: <br />Date: <br />