Laserfiche WebLink
City of Santa Ana COTC Office Use Only <br /> -�• ;,}, I Clerk of the Council <br /> AGREEMENT TERMINATION FORMTHE MUNCH_ <br /> I I <br /> j 4.-k N 10'i21-'�`2:2`mac <br /> Please complete this form in its entirety when the attached agreement and all l <br /> amendments (if any) are no longer in effect. <br /> i I <br /> Note: If your agreement is grant related,please ensure that all grant retention requirements I <br /> have been satisfied prior to signing the termination form. <br /> i I <br /> Is the agreement(s)a permanent record?Yes No I I <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. • <br /> E <br /> The agreement with N (;A'A n <br /> No. l !G7A) -- 1 (27 was completed on �� ()A) a-1 and final payment has been made. <br /> (List all amendments. Use space below if needed.) Department: `I-K 'n"1GI1 ( OW() <br /> Phone/Ext.: t"j 1 5 i <br /> Signature: <br /> Date: I()-I at 41 <br /> i:\agreementslforms\fcrm-agreement termination form_goldenrod.doc <br />