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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 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amendments (if any) are no longer in effect.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 />wells] <br />neT 23 Fe, ?5 <br />N-2017-132 / <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: -TI- a'V/� <br />Phone/Ext.: <br />Signature: � OXt iz JC P. (AiG n <br />Date: I)i lel- 11-1 <br />Revised: 10-18-16 <br />