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City of Santa Ana <br />- Clerk of the Council 5,P) VS <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amendments (if any) are no longer in effect.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 is <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use Oniv <br />ANA CITY CLERK <br />14123 AM11:34 <br />The agreement with lOS pINC^1f`IF$ SMSA llrllTrro Pft1ZtNFKtsltllo DIRIA V614UN <br />N 112E1£SS <br />No. A ^ 202o — ol4 iiii was completed on 262t and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PhR - VF4 . FNh. <br />Phone/Ext.: 014*w41— T+0.3 <br />Signature: � T <br />Ili <br />Date: dcl. lei. IZ02-L <br />!agreementoformemmin agreement termination form_goldenrod,doc <br />