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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amendments (if any) are no longer in effect. IM <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. PTY <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 PAJA(- <br />No. Ar- b lID was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10.18-16 <br />Cz0(b <br />SANTA ANA <br />C�P Gou'NCI: <br />J ( ile and final payment has been made. <br />Department: l i r f VIT <br />Phone/Ext.: 0 <br />Signature: ¢ 1� <br />Date: I � ) 3 A <br />