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,• >>+, City of Santa Ana <br /> ti °x, �: Clerk of the Council COTC Office Use Only <br /> ttiY'rM' <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 amendments (if any) are no longer in effect.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 /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. <br /> The agreement with i 4162.140 --- / ii 7y <br /> No. A—02Q/2 —// 0 was completed onAi /1 / and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: �� �/ <br /> Phone/Ext.: � 21 <br /> Signature: .Z 6, /71- (�A/e z-- <br /> Date: / q// rr <br /> Revised:01-07-16 / <br />