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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. 2016 <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. rIT.. <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 />Lv171 ` 1 jai P 6o <br />No. a"1 —701 s— 2:5-t was completed on <br />(List all amendments. Use space below if needed.) <br />Revised 01-07-16 <br />G ZI <br />.............. <br />COTC Office Use Only <br />31 AM {i= 34 <br />SANTA ANA <br />OF COUNCU, <br />7/1 I lit� and final payment has been made. <br />Department: ( M Ayl��IL' S Ge, <br />�t v <br />Phone/Ext.: L� <br />Signature: <br />Date: <br />