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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amendments (if any) are no longer in effect.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 NOX <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />C 201 <br />17 AUG, ?f( Fell i. <br />CITY Cr SANT; <br />CLERK ol- <br />The agreement with \C6iy1— <br />No. 2y1CGiVl W�1�j �a�tbl�a0 /1U`��tVl �l Un s <br />N-2017-019 was completed on J 2 I I 1 <br />(List all amendments. Use space below if needed.) <br />Revised: 10.18-16 <br />Department: <br />and final payment has been made. <br />C M$ <br />Phone/Ext.: X1:5 v� 1 <br />Signature: <br />Date: stv <br />