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City of Santa Ana• <br /> �___........__._... COTC Office Use Only ____....._.E <br /> -'� �' Clerk of the Council <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form when the attached agreement and all <br /> amendments (if any) are no longer in effect. I <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 /> i E <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 �4. en //i/A ZY/ / / <br /> No. 7 ' �7i _I Z/ was completed on and final payment has been made. <br /> (List all amendments. Use space below if needed.) / I <br /> Department: 1) <br /> Phone/Ext.: ;'€ 2/ <br /> Signature: 4A:Ao/`1-4t7 c )7.4 ld e#,‘_, <br /> Date: <br /> Revised:01-07-16 <br />