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City of Santa Ana <br />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amendments (if any) are no longer in effect.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 C:I Ei <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 Iv t <br />No. — l�lJ��^ '✓�j q was completed on '2 1-172 <br />(List all amendments. Use space below if needed.) <br />P�'Wlgi wJ � dA" <br />COTC Office Use OnN <br />OF THE CHLINCLI <br />_ 6 `21 PM2:53 <br />�r-2�f1-2�1 -02 <br />i.lagreementsliormslform- egrer? nt terminavtif mlgolden"-d0C' ✓� <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />and final payment has been made. <br />