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City of Santa Ana <br />` Clerk of the Council coTc office use only <br />7�r 1 ......... .... ..... <br />AGREEMENT TERMINATION FORM <br />Please complete this form 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amendments (if any) are no longer in effect.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 satisfied prior to signing the termination form. b1 T y OF SANTA <br />CLERK OF C , tt 1i <br />i <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />G <br />The agreement with t StjV+(A Avid 9�1\d1c �Ji3QOYM Ryli0l N -f t O� <br />No. A- LQ� U - �� K3 was completed on lll l y and final payment has been made. <br />(List all amendments. Use space beiow if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: ' ,l"hl lit, <br />Revised* 01-07-16 <br />