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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />c zoti� <br />COTC Office Use Only <br />; 1-5 PM * 20 <br />Please complete this form when the attached agreement and all CITY OF SMITA <br />amendments (if any) are no longer in effect.Gi <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 />N-2013-143 <br />No. was completed on 1)IL� and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Y �A <br />Phone/Ext.:, <br />Signature:�+1� c ,t)P VCk O <br />Date: 61,.E <br />Revised 10-31-12 <br />