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AA <br />City of Santa Ana COTC Office Use Only <br />`` Clerk of the Council <br />,. LUZL <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amendments (if any) are no longer in effect.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. i <br />1 TA A Nhq I GLEE <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). i <br />Call 647-] 520 if you have any questions. <br />i <br />The agreement with Toel �ancindez <br />Na. N-29�_ was cam leted an it <br />l� and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: , CS - <br />Phone/Ext.: 4 <br />Vl� r <br />Signature: <br />Date: l5 Z 3 <br />