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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 agreem r#i NLU c9l <br />amendments (if any) are no longer in effect. <br />TV <br />Note: If your agreement is grant related, please ensure that all grant retention requirern S, <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 />Pi"41?=2 <br />NT A Q <br />r AN A <br />LM17 <br />.................... <br />use Only <br />No N -1017-U52 was completed on IL2 /&/1 -7 rand final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: �,V—N'Iq <br />Phone/Ext.: <br />Signature: �J tt�% tltt (1 R�1✓ 1 <br />Date: <br />Revised: 10-18-16 <br />