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City of Santa Ana <br />t Clerk of the Council core office Use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and ail . <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amendments (if any) are no longer in effect.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 IZ <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 Yu Cyyl 0, <br />No. 41--z 11 was completed on y 0 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Al 1I I Department: Q(�CS <br />H <br />tj Co ��iT �J Phone/Ext.: 52-11� <br />ri Signature: (fb J(?J-- <br />Date: 11Ill 1z02� <br />Revised: 10-18-16 <br />