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°: City of Santa Ana <br /> COTC Office Use Only <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 amendments (if any) are no longer in effect. ?rr 17 <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements ' ' ' l <br /> have been satisfied prior to signing the termination form. I CITY <br /> OF sA <br /> CL c ril <br /> ; l; <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 Stiff /. (,/f) ���ff l � L/�Al c <br /> // / <br /> No. _ `" ��� _ was completed on , r-(7 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: 1--- / - I a..) <br /> Phone/Ext.: X. o/3 <br /> Signature: <br /> Date: , /y, /e <br /> Revised:01-07-16 <br />