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City of Santa Ana C UiZ <br />Clerk of the Council <br />u._ <br />AGREEMENT TERMINATION FORM -- —__ <br />COTC Office Use Only <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. C <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 n <br />N- 2012 -072 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: IF a, <br />Phone /Ext.: <br />Signature: s�igtAl, <br />Date: Z L ° <br />Revised 0 &2310 <br />