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C20 <br />City of Santa Ana <br />Clerk of the Council tort orrice use On <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all F ` SEP 1 R 16 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requiremgW1 _ A <br />have been satisfied prior to signing the termination form. L' <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. N-2016-119 was completed on 91WHp a and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: :PgZA <br />Phone/Ext.: 5D Sli <br />Signature: yJl?—'Qt o <br />Date: q 1'a I i LP <br />Revised: 01-07-16 <br />