Laserfiche WebLink
City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM Q `Q <br />Please complete this form in its entirety when the attached agreement <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amendments (if any) are no longer in effect.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 <br />No. -ao oS I U <br />T l — was completed on <br />(List all amendments. Use space below 9 needed.) <br />COTC Office Use Only <br />ANA CITY CLIE 2K <br />14'23 RMs i:33 <br />IL{ lzz and final payment has been made. <br />Department: <br />Phone/Ext.: IJS���'/� <br />Signature: yQ/LL- �7 <br />Date: <br />—T <br />ilagreementsiformaiform- agreement termination form_goldenrod.doc <br />