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City of Santa Ana <br /> Clerk of the Council <br /> I COTC Office Use Only <br /> --�� 1 <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 amendments (if any) are no longer in effect.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 retent,on 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 Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. <br /> The agreement with <br /> No. f t-- `€-' 0 was completed on J f 7/I b and final payment has been made. <br /> (List all amendments. Use space below if needed.) Paifi r �� <br /> Department: _ <br /> Phone/Ext.: X's Q / 3 <br /> Signature: I�� <br /> Date: Crag <br /> a„y .y. 10-1 3-16 MA- <br />