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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />rt9-1 f4+r <br />Please complete this form in its entirety when the attached agreemenI'-ahefra91 <br />amendments (if any) are no longer in effect. rITY 07 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements'n, r - n,, <br />have been satisfied prior to signing the termination form. "3 {" ' <br />Is the agreement(s) a permanent record? Yes No <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 />Office Use <br />PF? - ? 21 <br />N-2016-152 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: F12PI&A <br />Phone/Ext.: r. <br />Signature: C:f Lc" LI)PAK&O <br />Date: 101, Lb's n <br />Revised: 10-18-16 <br />