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City of Santa Ana <br />�1 Clerk of the Council core Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement andq <br />amendments (if any) are no longer in effect. AM 22 Ij: 14 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements C i T Ii OF SANTA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <br />Is the agreement(s) a permanent record? Yes _ No <br />Return form to the Clerk of the Council Office (M-30). i <br />Call 647-1520 if you have any questions <br />The agreement with <br />No. N-2016A85 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />I431 1 1 1 and final payment has been made. <br />Department: F 0,0,. *A- I Ad Y1Mio, <br />Phone/Ext.: Sp <br />Signature: L1 OA 0Pn/GVl <br />Date: % We I l � <br />