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City of Santa Ana Z6t 1 <br />......... f <br />Clerk of the Council cors office use only <br />.. ......... ......... <br />AGREEMENT TERMINATION FORM <br />er 1� rl 3 R -M 3- <br />Please complete this form in its entirety when the attached agreement ancPaFI <br />amendments (if any) are no longer in effect. <br />t; <br />Note' If your agreement is grant related, please ensure that all grant retention requirements )T { 0 1`7 SANTA <br />nt <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 0)�3l <br />No. N-2017-061 was completed on ,10 j7 and final payment has been made. <br />(List all amendments. Use space below ff needed.) <br />Department: <br />Phone/Ext.:5 <br />Signature:A �VZk^X ,CAJ�AI <br />Date: tVlP��l iclI t I <br />Revised 10-78-.16 <br />