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City of Santa Ana <br />Clerk of the Council coTc office use only <br />..... <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all i 7M AUG 2 ( FM S: n ( <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF SA N TA ANA <br />have been satisfied prior to signing the termination form. CLERK 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 I VQ1n(&� hires' cky c1i )ZC n <br />No. N-2017-109 was completed on Co /.;�Ojanjgand final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Pplcf - <br />Phone/Ext.: Z4. <br />Signature: (� h✓ <br />Date: <br />Revised: 10-18-16 <br />