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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety 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amendments (if any) are no longer in effect.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 />Is the agreement(s) a permanent record? Yes _ No _ <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 /V — f ;/� <br />No. /t/ –z;W n 0eW was completed on <br />�y (List all amendments. Use space below if needed.) <br />V -10M 014-Oi CIA) <br />n- 2®0S- 04 -n Ito.) <br />Ravisad: 10-18-16 <br />G 2,0 17 <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: ! l <br />