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oz-A, <br />City of Santa Ana <br />Clerk of the Council coTc office Useonly — ............................. <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreerr�,, q�d i �t fl <br />amendments (if any) are no longer in effect. �t"'``�y AA l(! <br />Note: If your agreement is grant related, please ensure that all grant retention requirem�a TY �� STA ANA have been satisfied prior tosigning the termination form, CLERK <br />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 Don , Ar1evnP_ Rug' n <br />No <br />N-2017-110 was completed on _Uwlaors and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRC F1, A <br />Phone/Ext.: y� tq. <br />Signature: )� <br />Date: <br />Revised: 10-18-16 <br />