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City of Santa Ana <br />Clerk of the Council core on1�e use <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. ate OCT 31 AN 11' 4 <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 OR SANTA ANik <br />CLERK QF COUNCIL <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />C Zol � <br />The agreement with L"� ►j�"I-! d+ Jen <br />No. �lf��� was completed on WV111P and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: '��� LiT ►)�� <br />Phone/Ext.: <br />Signature: <br />Date: t L� ✓l ! io <br />Revised: 01-07-16 <br />