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AV <br />City of Santa Ana COTC Office Use only <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM -SAIN TAI ANA MTY CLEIRK <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amendments (if any) are no longer in effect.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 <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 <qet)� 51Y <br />No. - N-2022-048 <br />(List all amendments. <br />was completed on <br />Use space below if needed-) <br />Department: u' ! <br />nagreementsVormsVorm - agreement termination form_goldenrod.doc <br />and final payment has been made. <br />Phone/Ext.: l (0 <br />Signature: <br />Date: <br />