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City of Santa Ana <br /> .' COTC Office Use Only <br /> ,-7;. - Clerk of the Counc <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and all <br /> amendments (if any) are no longer in effect. �, ? .. • , ra <br /> Notei If your agreement is grant related. please ensure that all grant retention requirements i.+ 1� <br /> have been satisfied prior to signing the termination form <br /> Is the agreement(s) a permanent record?Yes No <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 T /"'" b " " /Rb gssociylluc <br /> r <br /> No. / ' 2 --20 was completed on A -! /( ( and final payment has been made. <br /> (List all amendments. Use space below if needed.) pm — 0(J � A.)Department: <br /> Phone/Ext.: /3 soz <br /> Signature: (J• Ce ek-C <br /> Date: V <br /> Pe,tied. I -13-15 <br />