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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all16 AUG 22+ �; (?b <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY Qr M� I E1 i�NEi <br />have been satisfied prior to signing the termination form. IT Y O O F COUNCIL <br />AN <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 �¢! O✓{ ll���yU, <br />N-2016-075� <br />No. was completed on hdA and final yment has been made. <br />(List all amendments. Use space below if needed.) <br />Department:yp'C. S <br />Phone/Ext.: HL 1a <br />Signature: I <br />Date: n O <br />Revised: 0 1 -07-16 <br />