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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Y <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with Scott H. Wledy, DVM <br />No. 42003-080 CZAR was completed on 6/30/04 and final payment has been made. <br />(List all amendments. Use space below ff needed.) <br />Department: PRCSA <br />Phone/Ext.: 5254 <br />Signature: � Axe Ca- X jWJ y <br />Date: 5/13/14 <br />Revised 08-2310 <br />