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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 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements C! ty of Santa Ana <br />have been satisfied prior to signing the termination form. „ a 21 <br />Is the agreement(s) a permanent record? Yes No <br />CiF rk of the Council <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />p \_ I I <br />The agreement with A C> kA ck � "�� N o k1A <br />No. % `%CIa — Z l was completed on <br />(List aff amendments. Use space below if needed.) <br />Pr - aoV-1-333-01 <br />Revised: 10-18-16 <br />lj,�2qf _I_�<_ and final payment has been made. <br />Department: )? I Pei YVV\ tti <br />Phone/Ext.: G-a S7-� <br />//11 <br />Signature: a .kkop1 k/Y 1p <br />Date: -7_�lF� <br />