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City of Santa ' ha <br />Clerk of the Co�.lcil <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amendments (if any) are no longer in effect.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 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 />ANA CITY CLERK <br />14'23 AM11:33 <br />No. A —.7613 was completed on 3d / and final payment has been made. <br />(List all amendments. Us space below if needed.) <br />Department: n(�Z)7 <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 1418-16 <br />