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City of Santa Ana <br />f Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemgrlparp,�h4. <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requiremeVI T'� O <br />have been satisfied prior to signing the termination form. r n <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 />A PT .= <br />l z.4 <br />C' V ti <br />No. N-2017-015 was completed on a5h-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FRJ <br />Phone/Ext.: 7 <br />Signature: s2� � CA e,(QnfC O <br />Date: I otl n l 1-1 <br />Revised: 10-18-16 <br />