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n <br />City of Santa Ana <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amendments (if any) are no longer in effect.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 <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 />N-2022-085 r t <br />No„ -- ,e-Sers"was completed on i <br />(List air amendments. Use space below if needed.) ` . <br />Department: <br />COTC Office Use Only <br />C2-02,2- <br />1--ity of :7 atita An <br />0>ty Glerkc s Gff€(;e <br />and final payment has been made. <br />tA r� <br />Phone/Ext.: X <br />Signature: <br />Date: <br />i:�sagreementsftrmslkrm - agreement termination form—goldenrod.doc <br />