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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />� � 5 <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />t= <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 Joseph R. LA Rosa Jr. <br />COTC Office Use Only <br />3. JG <br />No. N-2012-134 was completed on 9-30-13 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Police Department <br />Phone/Ext.: (714) 245-8004 <br />Signature:�"���'®GGA <br />Date: <br />Revised 05-23 10 <br />