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City of Santa Ana <br />GO Clerk of the Council <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amendments (if any) are no longer in effect.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 -1520 if you have any questions. <br />The agreement with <br />No. N- 2012 -153 was completed on <br />(List all amendments. Use space below If needed.) <br />Revised 10.31 -12 <br />C, 201 <br />COTC Office Use Only <br />iA3015 and final payment has been made. <br />Department: <br />Phone /Ext.:`»�( <br />Signature: ACI, hJ � <br />Date: ( -]� }�( <br />