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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety 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amendments (if any) are no longer in effect.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 />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. N-2016-158 wac cpm t <br />(List all amendm(,� <br />�� <br />�y _.tonk\ <br />Revised: 10.18-16 <br />C20t6 <br />COTC Office Use Only <br />on I) ) ict j) U and final payment has been made. <br />Department: TLQ-2,A <br />Phone/Ext.: <br />Signature: l�Al P pQnT J ✓ti <br />Date: I�[� <br />