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City of Santa Ana <br />.. Clerk of the Council core office us, only <br />.ate, <br />AGREEMENT TERMINATION FORM <br />Please coete 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amendments (if any) are no longer in effect.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 (,7C AJC-SS (-6/WJa'CJ-70Ar, .:AJC/ <br />No. A 7 _ a was completed on �! 3G �✓ and final payment has been made. <br />(List all amendments. Use space below if needed.) %�j� n EI <br />Department: l �" bec(C7� A+T . <br />Phone/Ext.: <br />Signature: L <br />Date: <br />➢-,i57 I; I3-IS <br />