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City of Santa Ana <br />Clerk of the Council coTc orrice use <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amendments (if any) are no longer in effect.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. r-LER K OF THE 03UNyCI <br />Is the agreement(s) a permanent record? Yes No <br />AUG 2121 PM:30 <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-2017-108 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRE sA <br />Phone/Ext.: U2Aa A <br />Signature: [s)h)an/ <br />Date: 9 (161in <br />Revised: 10-18-I6 <br />