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City of Santa AnaC <br />.................................... . . . ................................. <br />Clerk of the Council COTC Office Use Only <br />- ---- --- - -- <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. 70M OCT131 AM If-* 35 <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. -VITY OF SANTA ANA <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. A - was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />V <br />Date: <br />Revised: 01-07-16 <br />