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City of Santa A t <br />Clerk of the Cou..:il <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amendments (if any) are no longer in effect.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 />(-.rill 647-1520 if you have any questions. <br />The agreement with <br />No. Ay7-2Cl1-I' 6) D was completed on <br />(List all amendments. use space below if needed.) <br />Revised: 10-18-16 <br />Use only <br />City of Santa Ana <br />p.1J02M1 <br />Clerk of the Council <br />) <br />and final payment has been made. <br />Department: <br />Phone/Ext.: (ate L <br />Signature:. <br />Date: <br />