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City of Santa Ana <br />Clerk of the Co, cil �VG ---CO—TC- Office ---U-s-e-- 0---n-ly---- <br />... .. .. .. .. - ..................... ...................... . .. . ......... <br />AGREEMENT TERMINATION FORM <br />CLERK OF THE COUNCIL <br />Please complete this form in its entirety when the attached agreement and <br />28123 PM4:32 <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amendments (if any) are no longer in effect.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 1 CvmNc� 0,0 o L <br />U U <br />No. A-2018-135-04-A was completed on jut [ and final payment has been made. <br />(List off amendments. Use space below if needed.)--- I <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: Il I t <br />Revised: 10-18-16 <br />