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City of Santa Ana <br />Clerk of the Council <br />tee€; <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amendments (if any) are no longer in effect.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 Ci Ef <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 M ( <br />No. h w— `/�q was completed on %i?J <br />(List all amendments. Use space below if needed.) <br />_ICI t'IYj L{2(�1 Q� Uj ilii of <br />2 r?� 2 ►`l <br />:711 i <br />COTC Office Use OnN <br />9F THE COUNCIL <br />_ 6 `? 1 Pm2: e3 <br />f�-2ol'I-�I -02 <br />hagreementsWormslform -agltt term; a5 Pfjgddeni.d: <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />and final payment has been made. <br />