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City of Santa Ana <br />�r <br />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amendments (if any) are no longer in effect.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 />Is the agreement(s) a permanent record? Yes No r <br />Return form to the Clerk of the Council Office (M-30) . <br />Call 647-I 520 if you have any questions. <br />The agreement with YWA, 0 0A Nsir e <br />COTC Office Use Only <br />CLC)�"L- <br />OtV of Santa Ana <br />"'�1tyClerk's Office <br />No. N-2022-039 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: , <br />hagreementsVormsVorm - agreement termination form_goldenrod.doc <br />