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City of Santa A <br />�q Clerk of the Council corc Office Use o�y <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amendments (if any) are no longer in effect.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 />Cify of Santa Ana <br />Note: If your agreement is grant related, please ensure that all grant retention requirements I <br />have been satisfied prior to signing the termination form. `; j o 2 2' <br />Is the agreement(s) a permanent record? Yes _ No <br />Clerk of the Council <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. was completed on t ';J311) al and final payment has been made. <br />(list all amendments. Use space below if needed.) i�/—� p � c <br />t Department: ��PAWiK <br />`O� _Q <br />Phone/Ext.: <br />Signature: fG&A) a Qk�(Vftn <br />Date: 71ac-I la-� <br />Revised: 10-18-16 <br />