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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />HM, l0m; I L3 -IN <br />5u <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. Q T <br />r-V- <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-2012-053 was completed on ( ,�?- and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: 5 LSLA <br />Signature: <br />Date: <br />Revised 08-23-10 <br />