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City of Santa Ana <br />'1 <br />Clerk of the Council <br />~� <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all 2g1gUG 27 �: !i 6 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF S ANTA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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 />No. N-2016-066 was completed on (n(--� and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: -PPTS&P� <br />Phone/Ext.: sa�:) <br />Signature: Z-A Q 0\ Q , CjhQNICAQ, <br />Date: <br />Revised: 01-07-16 <br />