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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 <br />amendments (if any) are no longer in effect. <br />s+ <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 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 />Office Use Only <br />a,= -ST <br />A A <br />Ff5 hlr+ �, 3•,F F.t <br />G ZOf -1 <br />No. N-2017-057 was completed on 5/0-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: -V (� , <br />Phone/Ext.: 6LS 1 nn <br />Signature: A-- LV vldlQAJCkD <br />Date: I () 11R t n <br />Revised: 10-18-16 <br />