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City of Santa Ana <br /> = Clerk of the Council <br /> AGREEMENT TERMINATION FORM <br /> COTC Office Use Only <br /> Please complete this form when the attached agreement and all <br /> amendments (if any) are no longer in effect. <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-6520 if you have any questions. <br /> The agreement with , 4 t <br /> No. t e--',��� was completed on - /c and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: pgA <br /> Phone/Ext.: f` S 13 <br /> , �c <br /> Signature: � t- � 7' <br /> Date: �- 7 <br /> Revised 08-23-10 <br />