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P� City of Santa Ana <br />' ` '�. t Clerk of the Council corc Office usa only <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 e!fect. ng DEC 123 AM 9- fig <br />Note: If your agreement is grant related, please ensure that all grant retention requiremet t <br />have been satisfied prior to signing the termination fcrm. ll::!! Y OF q t ! TAANA <br />CLERK i��G(TtJN {( <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 it you have any questions / } n t <br />The agreement with 1 f�'l� ✓ `1 rS _ c`` ! "j63, <br />No. /%_l a�s — / 7 3 was completed on 0 S and final payment has been made. <br />(List aU amendments. Use space below if needed.) 71� _ <br />r 73 --0 <br />Ra,!sed: 10-13-16 <br />Department: LIlUIT (-?/v <br />Phone/Ext.: <br />Signature: <br />Date: <br />