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City of Santa Ana <br />�B. ....... .......... <br />Clerk of the Council corc <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amendments (if any) are no longer in effect.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 />SEP 25.PR 1 <br />Note: If your agreement is grant related, please ensure that all grant retention requiremn f�j y <br />have been satisfied prior to signing the termination form. {+ . , C i h. <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-2016-133 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />a -01b <br />Use Only <br />JW I Ift and final payment has been made. <br />Department: Tgp e , <br />Phone/Ext.: <br />Signature: iA J0AA� <br />Date: (�?j <br />