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City of Santa Ana <br />�r v Clerk of the Council I corc Office Use only <br />-� <br />I---------- <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amendments (if any) are no longer in effect.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 'G`- <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. i p^ <br />The agreement with ��e r� vY1 Y 1�A/1C� � �� YJ rut(Ak •( <br />No. 0 - -,�OV 1 ',26%1^ was completed on 3' and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Y p-(� <br />Phone/Ext.: t; <br />Signature: <br />Date: a <br />Revised: 10-18-I6 <br />