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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemenmgfm, <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requireni T Y <br />have been satisfied prior to signing the termination form. CLERK <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 NA--rlotlA-i- CsvoL�.kiorJ <br />COTC Office Use <br />0 An 9.- 36 <br />F COUNCIL <br />No. N - z41$ - Mo was completed on a � ' i 19 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />?V%IA <br />Phone/Ext.: <br />33 <br />Signature: <br />Date: <br />3 a I -Z"' <br />Revised: 10-1 a-16 <br />