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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form 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amendments (if any) are no longer in effect.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 poor to signing the termination form. <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 <br />No. was completed on —6/ljp <br />(List all amendments. Use space below if needed.) <br />2_�� �z—�_6� ��Q, / Department: <br />ob8 aua Phone/Ext.: <br />Signature: <br />Date: <br />Revised:01-07-16 <br />G w1b <br />Office Use <br />CITY <br />I-SANTA <br />r- <br />CURK OF <br />and final payment has been made. <br />