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City of Santa AnaGZe <br />-....... <br />T 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amendments (if any) are no longer in effect. fs OCT 21 M If: 34 <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. CITY OF SANTA ANA <br />CLERK OF CO! MML <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 �611a) WA_�;n\A'YDVWw+At &+t'VYMe1jj'S' Im, <br />No. � ` ILL Jlp— )7(P was completed on '1�ittli) to and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 6N n )� 6*ft e <br />Phone/Ext.: X�IAO <br />Signature: <br />Dater liy <br />Revised: 01-07-16 <br />