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City of Santa Ana <br />-All 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amendments (if any) are no longer in effect.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 prier 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 I tJY� <br />N-2022-008 � <br />No. was completed on j — <br />(List all amendments. Use space below if needed.) y <br />iA@greementstformslform - agreement termination formTgoldenrod,doc <br />Department: <br />COTC Office Use Onl <br />V - D7_ Z' <br />r <br />U` RK <br />s ,"` 233 <br />and final payment has been made. <br />Phone/Ext.: <br />Signature:' <br />Date:,J 4 <br />