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City of Santa Ana <br />Clerk of the Council ---- - ---- ----- ------ -- - - - --------- <br />6 -- .......... .... <br />COTC Office Use Only <br />1 <br />......... ............ ......... . ...................... - ---------- <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all 25 pp 3: <br />amendments (if any) are no longer in effect. -4 <br />Note: If your agreement is grant related, please ensure that all grant retention requirement" T Y OF A H TA <br />have been satisfied prior to signing the termination form. 5C L E Rq rj�r' <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 AA S AA— SVTa C�� oj� G -02,Y -V � I ci" <br />No. was completed on qt?>t I I (V and final Payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Revised: 01-07-16 Date: <br />