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City of Santa Ana <br />Clerk of the Council -com Moe Use-- Only <br />------- - ------------ - <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amendments (if any) are no longer in effect.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 />PRIF ?K Is the agreement(s) a permanent record? Yes _ No 47 <br />F1 n �Q c-g <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 />No. <br />N-2018-072 was completed on Q4.L30f2biq and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department: f RC15N <br />Phone/Ext.: <br />Signature: <br />Date: iti MS 702 <br />Revised: 10-18-16 <br />