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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />2T91 <br />Please complete this form in its entirety when the attached agreement anc} II) <br />amendments (if any) are no longer in effect. CI T Y O e <br />Note: If your agreement is grant related, please ensure that all grant retention requirementEC ERK <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 />The agreement with rk-Z`r`O� <br />ZblS <br />No. _ l� was completed on <br />(List all amendments. Use space below if needed.) <br />�2 /(o 7 <br />COTC Office Use Only <br />AM 4= 50 <br />,NTA ANA <br />COUNCIL <br />U `✓ �� % and final <br />`�,�payment has been made. <br />y� Department: �� y b :�-/g/ <br />l62 ° `� <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: I 0-18-16 <br />