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City of Santa / j <br />l4i 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amendments (if any) are no longer in effect.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 T 6 <br />Core Office Use Only <br />City of Santa Ana <br />Clerk of the Council <br />p-2019-146 <br />No _ was completed on ll? I C and final payment has been made. <br />(", ,,., .,menaments. Use space below if needed.) <br />Department: RQ-(s'�A I ``1tiVY`." <br />Phone/Ext.: So�S <br />Signature: <br />Date: -Z bjO1-=)-A <br />Revised, 10-18-16 <br />