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rIty of Santa Ana <br />` .;lerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <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 />No. X- �% — o �-L was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />OF T HI: COUNCII <br />12312' Httg:41 <br />and final payment has been made. <br />-4 <br />Phone/Ext.: �� p <br />Signature: (Ta-a , <br />Date: S <br />Department: <br />