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City of Santa Ana <br />Clerk of the Council core Office Use Only <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amendments (if any) are no longer in effect.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 />Return form to the Clerk of the Council Office (M-30). <br />Call 647-6520 if you have any questions. <br />f <br />The agreement with v. <br />No. N-2012-122 was and final <br />on completed payment has been made. <br />p � � � <br />(List all amendments. Use space below if needed) p <br />Department: P <br />Phone/Ext.: <br />�c2—�—� <br />Signature:r1`1 <br />Date: <br />Revised 08-23-10 <br />