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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION _FORM <br />Please complete this form in its entirety when the attached agreement NOT' t: T. 23 i7-4, 733 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements 11 Ty LII—, q A - <br />have been satisfied prior to signing the termination form t, £ <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 />Use Only <br />The agreement with I YUt 'CuY %Y '- -,-VV <br />No. N-2017-196 was completed on 9)10111-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: ?fz-Q-S4 <br />Phone/Ext.: �-� <br />Signature: 'Q' Zdx .\ I)QAmy) <br />Date: 1 0) n I. 1I <br />Revised: 10-1& 16 <br />