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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only ' <br />i 3 t9 I <br />217 t <br />Please complete this form in its entirety when the attached agreement and all ( N ANA <br />amendments (if any) are no longer in effect. 11,E OF o Il <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 <br />No. ' 1-2bl ` jq�e was completed on I t1 and final payment has been made. <br />(List all amendments. Use space below if needed) <br />N-2-01 - Re- 01 <br />Department: P mom )YlC'I tul-es <br />Phone/Ext.: -} <br />Signature: 0-1 t (t 1i Yu131rLi <br />Date: i 0 Elf <br />Revised:10.18-16 <br />