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oCity of Santa Ana <br />f'i t Clerk of the Council <br />�` AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <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amendments (if any) are no longer in effect.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 />Is the agreements) a permanent record? Yes No <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. )T-704�� was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-1316 <br />c 20[7 <br />COTC Office Use Only <br />11 felt 15 pM !- IS <br />S H,AAN'A <br />;a 1t. <br />X and final payment has been made. <br />Department: (� _ �� %► ' r <br />Phone/Ext.: <br />Signature: <br />Date: <br />