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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety 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amendments (if any) are no longer in effect.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. <br />Is the agreement(s) a permanent record? Yes No* <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 k-yIMA 11 !A `OT-e'6lt 54w\l <br />No. k'26 1U — 114_ was completed on <br />(list all amendments. Use space below N needed.) <br />Revised: 10-18-16 <br />Czpl <br />'ice Use Only <br />M6 OCT 31 AN <br />ITY OF SA T� <br />CLERK OF Cuff <br />�k' and final payment <br />�has been made. <br />Department: G� Mg! • s O3'u <br />Phone/Ext.: x 15 7111 'A <br />Signature: gg <br />Date: <br />