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�, City of Santa Ana <br />�—l! Clerk of the Council cord office use <br />!'.~ ............ <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amendments (if any) are no longer in effect.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 . -- t 1 <br />Call 647-1520 if you have any questions. <br />The agreement with <br />No. /�✓ C% 9 6 7 was completed on A1.13111Q0 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: YMBIK <br />Phone/Ext.: 51191 <br />Signature: <br />Date: Mot 12o21. <br />Revised: 10-18-16 <br />