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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. M <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. ,4T, <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 />... .._�. <br />COTC Office Use Only <br />31 AN It= 34 <br />SANTA ANA <br />OF GOUHf,�ii- <br />Aidt�-fitnS ®Ci`�lf`G <br />No. h ` w w —1 J'l was completed on b and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: ` '—�i �a' 4 t <br />Phone/Ext.: 114 <br />Signature: ] 2 <br />Date:UI JI ('�p <br />Revised: 01-07-16 <br />