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City of Santa Ana <br />-* t Clerk of the Council <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amendments (if any) are no longer in effect. <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. <br />Is the agreements) 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 <br />No. N-2016-173 was completed on <br />(List all amendments. Use space below if needed.) <br />AUG h i PM 5- n 0 <br />TY OF SANTA ANA <br />LERK OF COUNCIL <br />U <br />jaAl lilj7 annd final payment has been made. <br />Department: T VI C A <br />Phone/Ext.: 9a n <br />Signature: TUA, <br />Date: iao1a <br />Revised: 10-18-16 <br />