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City of Santa Ana <br />' tit Clerk of the Council -- core office use ortly <br />AGREEMENT TERMINATION FORM <br />_ Please complete this form in its entirety when the attached agreement and all � ?N9 JUL 19 FMI3� I I <br />amendments (if any) are no longer in effect. <br />CITY Or SnAN <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CGA <br />Fp(t c COUNCIL TA TAAN 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 <br />.I <br />No. t (1p "-)'l Q was completed on <br />(List all amendments. Use space below N needed.) <br />l( �� and final payment has been made. <br />Department: A,,04 <br />Phone/Ext.: x1 (' <br />Signature: � i� l "'7 LT <br />Date: IfZ2,6zli <br />Re,sed 10-I3-16 <br />