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City of Santa Ana <br />M <br />Clerk of the Council coTcOffice Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement MG', 21 PM 5'- n0 <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amendments (if any) are no longer in effect.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 OF S ANTA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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-2016-181 was completed on I of ij and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: mcfsk <br />Phone/Exf.: �119 iq <br />Signature: i <br />Date: 01(41 2cu <br />Revised: 10-16-16 <br />