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City of Santa Ana <br />® � Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use <br />Please complete this form in its entirety when the attached agreement and allr19 Mr, 2 E ?� 5 <br />amendments (if any) are no longer in effect. MAI <br />Note: If our agreement is rant related, lease ensure that all rant retention requirements Y or S A <br />OF r colICIL <br />have been satisfied prior to signing the termination form. CLERK <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 <br />No. N-2016-025-001 <br />was completed on <br />(List all amendments. Use space below if needed.) <br />12 L�j JQj�:j and final payment has been made. <br />Department: PRc LA <br />Phone/Ext.: L1910. <br />Signature: ( ��sri1/cZ+ IY//i <br />Date: �31Iq 1ROIQ, <br />Revised: 10-18-16 <br />