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City of Santa AnaC <br />....... <br />� T Clerk of the Council coTcorrrceUse Only <br />.......... <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all n -a" jr F <br />amendments (if any) are no longer in effect.jh� <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. CITY 0. ` <br />CLERK <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 N-2016-135 was completed on and final payment has been made. <br />(List all amendments. Use space below H needed.) <br />Department: ?ice <br />Phone/Exf.: ,j D-5-1+ <br />Signature: �fl Q�CC,�ILkAkfD <br />Date: C41&DA-i%6 <br />Revised: 01-07-16 <br />