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City of Santa Ana <br />-� Clerk of the Council corc orrice use onq <br />r4 <br />AGREEMENT TERMINATION FORM <br />I <br />Please complete this form in its entirety when the attached agreement and all I <br />amendments (if any) are no longer in effect. — 17DA t" P ?I Pf 12: QO <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination for ;A <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 �" , �rtt jl (_ ( Nl�1 v 7 7-7n _. _ A 4 <br />No. N-2019-202 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />and final payment has been made. <br />Department: l <br />Phone/Exf.: t` <br />Signature: <br />Date: IZ,) /Z1 <br />21 <br />