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City of Santa Ana <br />' <- t Clerk of the Council coTc office u:� Only <br />0 <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement an2ugl OEC 12 kti 9. 50 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements C� r S A I <br />have been satisfied prior to signing the termination form. E K Qi COUNCIL <br />AN <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 />No. �/ — d was completed on M 3 and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department: <br />Phone/Ext.:�� �3 <br />Signature: <br />Date: <br />Rw,sed: 10-13-16 <br />