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City of Santa Ana <br /> Clerk of the Council Corc Office Use Only <br /> =;11 <br /> •+ AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and all <br /> amendments (if any) are no longer in effect. CITY <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 agreement(s)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 /> r 6nAd4re.} <br /> The agreement with (AVt <br /> No. A tJ 'n`(C(J 2j was completed onjth_g___ and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: i V� a -- _ 0 <br /> Phone/Ext.: XQ <br /> Signature: <br /> Date: ) / ' ! <br /> Revised' 10-13-I o <br />