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City of Santa Ana COTC office use Only <br />City Clerk <br />AGREEMENT TERMINATION FORM <br />Please complete this farm in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. City of Santa Ana <br />Nate: 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 <br />Return form to the City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with 31 <br />City Clerk's Office <br />` - Q 3-160 � �! an <br />No. was completedon d final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Tom' <br />Phone/Ext.: <br />Signature: 01 <br />Date: C <br />!-%nnenmmnniclinrmrlfnrm - anraorrIP t tarminatinn form nnldp.nrM dc-fr <br />