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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 ' AtIf; 22 EM 4: 04 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF SA NTA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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 />No. N-2017-079 was completed on (QL'� I y and final payment has been made. <br />(List all amendments. Use space below N needed) n 1 <br />Department: T"9-lor / Irttil;au,( j <br />Revised: 10-18-16 <br />Phone/Ext.: S—,p—S14- <br />Signature: t�EP"o\-C-.,Qt yoy-I <br />Date: %� (Y <br />