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City of Santa Ana <br />1 Clerk of the Council core 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amendments (if any) are no longer in effect. <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. CLERK OF THE B <br />ALIG 2'21, pm, :27 <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 <br />No. <br />N-2016-085 t' <br />was completed on (1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />Department: r �GA <br />Phone/Ext.: gdtok <br />Signature: (naOrQ�2� <br />Date: ! 11r zw <br />