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City of Santa Ana <br />Clerk of the Council <br />I <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amendments (if any) are no longer in effect.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. <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />NkeSS1t7hGl ;iht2ftGlhmCRi GOhSUI <br />The agreement with <br />COTC Office Use <br />SEP 25 PM 12 <br />W c a t.:IT'% to114k' <br />C' 261 <br />N-2016-091 ( <br />No. was completed on ° and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: T, �l A <br />Phone/Ext.: (� <br />Signature: <f y 121)G,JI tj1QAl�� <br />Date: 0 <br />Revised: 01-07-16 <br />