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City of Santa Ana core office use only <br />�'"-n =-�� Clerk of the Council <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amendments (if any) are no longer in effect.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 <br />have been satisfied prior to signing the termination form. <br />/1 <br />Is the agreement(s) a permanent record? Yes Na i I J 1'. - 1'2 3 P m6: �2 <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. N-202was completed on <br />(List all amendments. Use space below if needed.) <br />i:tiagreementsVorms+farm - agreement termination form_goidenrod.doc <br />i I ]ei and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />''rr <br />Date; �� ;,tz <br />