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n <br />City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemefif ibhbi c <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements P <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 />N-2017-050 <br />No. was completed on `7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FVX-&Ii4 <br />Phone/Ext.: 5D- - <br />Signature: ;ELU})Lo" , C@_kVCKO <br />Date: IN 101-7 <br />Revised: 10.1&1 <br />