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• 'Yr City of Santa Ana <br /> �,;,r t� Clerk of the Council i COTC Office Use Only <br /> y i <br /> ,.tip <br /> '.,,�'"'"'.,' 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 amendments (if any) are no longer in effect.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 /> 1 <br /> The agreement with ,3 u '7k �?' . /)/57 71- C <br /> No. ft") 2C�/z `//% was completed on /�d/?At_c and final payment has been made. <br /> (List all amendments. /Use space below if needed.) <br /> Department: (�/2 i <br /> Phone/Ext.: 2Z 21 <br /> Signature: /.. ,,,-�i7/ vi4 ,1iE <br /> Date: / 4 l <br /> Revised:01-07-16 <br />