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ow <br />City of Santa Ana <br />-Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemzint mQC1112949 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related', please ensure that all grant retention requirem;hT Y OF SA! N T# ANA <br />have been satisfied prior to signing the termination form. CLER11k (tFirni wro <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 /'R <br />No. / � CS was completed on <br />(List all amendments. Use space below if needed.) <br />fl —17 a -- 0/ <br />�76 -OS- <br />S and final payment has been made. <br />Department: /v y—� ����7 Aj <br />Phone/Ext.: <br />Signature: U' <br />Date: '1* <br />Revised: I U- 18- 16 <br />