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City of Santa Ana <br />Clerk of the Council COTC Office Use Only <br />. . . . . .... ........................................... ....................... <br />AGREEMENT TERMINATION FORM <br />7 M ti. 3:) <br />Please complete this form when the attached agreement and all <br />amendments if an are no longer in effect. CITY <br />R 1" <br />C C7 <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 <br />(List all amendments. Use space below if needed.) <br />77 -" - ?n <br />k!15 <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />and final payment has been made. <br />Revised 10-31-12 <br />