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City of Santa Ana G <br />Clerk of the Council cordofr«e use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />27 ' $« <br />amendments (if any) are no longer in effect. _ <br />f)S� ` <br />Note: If your agreement is grant related, please ensure that all grant retention requirements ii � � --- <br />have been satisfied prior to signing the termination form. CLnr - -rF <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�Yi1p <br />J j (t <br />No. A—�`Le—C3� <br />was completed on <br />((S� ���g <br />and final payment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department: <br />-?ajo=s�if�r <br />Phone/Ext.: <br />573L q <br />Signature: <br />jss LKc'�' <br />Date: <br />q j ill Wf <br />Revised: 01-07-16 <br />- <br />