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City of Santa Ana <br />r Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />amen (if any) are no longer in effect. <br />Please complete this form in its entirety when the attached agreement and all <br />7T7 AUG 21 Fi 1 S' f,. f <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. CITY OF SANTA ANA <br />Is the agreement(s)apermanent record? yes _ No CLERK OF 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. N-2017-111 was completed on <br />(Lisf all amendments. Use space below if needed.) O C t$ and final payment has been made. <br />Department: <br />Phone/Exf.: <br />Signature: AAO—� <br />Revised: 70-18-16 Date: CIIq <br />