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a <br />City of Santa Ana <br />t Clerk of the Council (KOF <br />OTC Office Use C <br />~ _ AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and allEFiE COi1NCIiamendments (if any) are no longer in effect. —22 AN9:16 <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 v <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 UP-h-r.1 (,s C-CJt 3T,4 WA --rev, pl s-TPa LT <br />No. h - J-0 i • 13 i was completed on ry( 3 t) 1—t and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature:��_ <br />Date: <br />Revised: 10-1 &16 <br />