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City of Santa Ana <br />Clerk of the Council <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amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been safisfied 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 U(/ u'b fi-iy <br />No. A _�r /� d was completed on <br />(List all amendments. Use space below it needed.) <br />COTC Office Use Only <br />2n"`� C 12 AN 9. SU <br />CITY OF c�,�+T <br />CLOF CO NC L� <br />( and final payment hasbeenmade. <br />Department: <br />Phone/Ext.:- <br />Signature: <br />Date: <br />Re lsed: I C-13-16 <br />