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City of Santa Ana 02012 <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />- - 1 7 <br />Please complete this form when the attached agreement and all = <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />No. N-2012-043 ' was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 1p 4 <br />Phone/Ext.: <br />Signature: �,� ®t 51 CA—) <br />Date: .4 Z+1 a.�-y f " <br />Revised 08-23-10 <br />