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City of Santa Ana <br />DAGREE <br />Clerk of the CouncilMENT TERMINATION FORM <br />Please complete this form <br />r in effect. the attached agreement c <br />amendments (if any) <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). <br />C'nll 647-1520 if you have any questions. <br />The agreement with <br />COTC Office �s? Only <br />OF THE COUNCIL <br />131123 PY047 <br />No. <br />N-2021-205 was completed on } I and final payment has been made. <br />(List all amendments. Use space below if needed.) Department: C I�Ia <br />Phone/Ext.: 655,, I <br />Signature: LE <br />Date: <br />yrcai. enGfor -o*1-agreain I R -1 an fa 1, - <br />�� <br />