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City of Santa Ana <br />t Clerk of the Council <br />AGREEMENT TERMINATION FORM 7M? DEC 12 AM <br />Please complete this form in its entirety when the attached a r t Qnd al <br />amendments (if any) are no longer in effect: ) V ENT <br />+T <br />CLERK OF COI <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination fc m. <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 />F <br />No. /r✓ 17� was completed on <br />(List all amendments. Use space below If needed.) <br />lr -/7S-6 / <br />/7S -�y <br />Use <br />SD <br />and final payment has been made. <br />xso r3 <br />J. Cfi-8RleL <br />r�l /r9 <br />Department: <br />Phone/Ext.: <br />Signature. - <br />Date: <br />Revised: l U- I B- 16 <br />