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City of Santa Ana <br />Clerk of the Coule <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amendments (if any) are no longer in effect.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 />0 <br />COTC Office Use Only <br />The agreement with ,0Jr % r) "tii % ., x <br />No. N-2016-132 was completed on 12/2,1 /2^-()j(�, and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />MC E)A <br />Phone/Ext.: <br />Ling <br />Signature: <br />Date: <br />Revised' 01-07-16 <br />