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°,r City of Santa Ana <br /> .p .-) ,y COTC Office Use Only <br /> L.;ii t' Clerk of the Council <br /> AGREEMENT TERMINATION FORM ,,. 7: n q <br /> { <br /> Please complete this form when the attached agreement and all C,:'flu _c a l <br /> amendments (if any) are no longer in effect. <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 /> ) <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 `f/ VC-;- 7� r/ V T 6 P., <br /> No. ( C' /(e) .—G , was completed on '5 1, ( and final payment has been made. <br /> (List all amendments. Use space below if neede -f(Department: ��v /q 'bE/' Al <br /> Phone/Ext.: IX 6 i 3 <br /> Signature: /24fC 7 <br /> Date: 2 <br /> ! /r g <br /> Revised:01-07-16 <br />