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- City of Santa Ana <br />*fit Clerk of the Council <br />,h <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amendments (if any) are no longer in effect.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 />Nate: 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 I - <br />Return form to the Clerk of the Council Office (Nt-30). <br />Call 647-] 520 if you have any questions. <br />The agreement with r <br />M <br />COTC Office Use Only <br />City of Santa Ana <br />JAN 11 2024 <br />City Clerk's Office <br />aG( A nzG4 <br />N-2022-022 V <br />No. was completed on 3w 1 7 7, and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />aepartme'ftt: <br />Phone/Ext.:, <br />rt <br />Signature:, <br />is <br />Date: iT7 <br />agreementslformslform -agreement termination farm_goldenr©d.doc <br />