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City of Santa Ana <br /> • 3 ' �1' Clerk of the Council COTC Office use only <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 amendments (if any) are no longer in effect.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 prior 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 ,:'k9n/dpyy 0/9•A-)72ti ;J (L-1/1/-(4-7217 /_ 7f-'('T_ <br /> No. -- —/ 3 c-J was completed on /3G7 26D7 and final payment has been made. <br /> (List all amendments. Use space below if needed.) f�/ � <br /> Department: (/� <br /> Phone/Ext.: 26 z/ <br /> Signature: �rS'Cl' � • Jt✓�� � <br /> Date: 9 <br /> Revised:01-07-16 <br />