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,,.,r City of Santa Ana <br /> r �.• Clerk of the Council I COTC Office Use Only <br /> AGREEMENT TERMINATION FORM r <br /> i <br /> Please complete this form in its entirety when the attached agreement and all 1 70! I� � ra 4; <br /> amendments (if any) are no longer in effect. 57 <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements CLERK'~ SA fd T,q ANA <br /> have been satisfied prior to signing the termination form. OF COUNCIL <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 )i A f*. Of Fk L.Litt..S GAL F4( O' <br /> No. /4 -0 0/ 79'3 was completed on iG rZ`t 1q and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: `IN eC C- Mr. <br /> Phone/Ext.: "7 � ��5 v al 7Lk <br /> Signature: / Lj <br /> Date: k..ii 3 fc <br /> Revised:10-18-16 <br />