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City of Santa AnaG` <br />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amendments (if any) are no longer in effect.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. iTy of cjANTA A14A <br />CUA 05 COUIRM <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 �11%f1Q �UL� I�WYE//�yy19i/VB9i1� UVt41Gi j1d� <br />No. �'r r Vd 1Y" <br />! +�l�P � �� °'� was completed on � � and final payment has been made. <br />(List all amendments. Use space below if peeded.) <br />Department: ct h�tj ^(,t <br />Phone/Ext.: t <br />Signature: y ) J <br />Date: <br />Revised: 01-07-16 <br />