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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. 771P Ulf'i 32 M D 57 <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 <br />No. /� —�%O _ was completed on *10' and final payment has been made. <br />(List all amendments. Use space below if needed.) t�'i / -7y 2j15- <br />Department: <br />Phone/Ext.: X�U i J <br />Signature: j %C' w 6 <br />Date: 10124 t 7 <br />Revised: 01-07-16 <br />