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0_.w; City of Santa Ana <br />'t tort Office u: OnlyClerk of the Council <br />�' AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement qnd all <br />L it P'��, 1 i � AN <br />amendments (if any) are no longer in effect. _9, q9 <br />Note If your agreement is grant related. please ensure that all grant retention requirements C <br />have been satisfied prior to signing the termination form. L � V SAMOTVA NA <br />Is the agreement(s) a permanent record? Yes _ No MOIL <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 coA s U�, 7 I � !9 2-C <br />No. A - was completed on <br />(List all amendments. Use space below if needed.) <br />Radsed 10-13-16 <br />i and final payment has been made. <br />Department: 16AJ6�� �C7 <br />Phone/Ext.: <br />Signature: <br />Date: / <br />