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rK City of Santa Ana <br /> COTC Office Use Only <br /> _ 4�1 Clerk of the Council <br /> wyy,Y" AGREEMENT TERMINATION FORM <br /> Please complete this form when the attached agreement and all <br /> amendments (if any) are no longer in effect. <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 /> • <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. - • <br /> • <br /> The agreement with $/Jgid & 0 A) 5 a e/ T/Z � J/c� rbit- <br /> No. - ,Zd/2- -f/5---- was completed on 47c)//.9 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: CD <br /> Phone/Ext.: -2�i 2_/ <br /> Signature: 6 ii s/ ebl-eL <br /> Date: Voe// 0 <br /> Revised:01-07-16 <br />