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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amendments (if any) are no longer in effect.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 />IN0. N-2022-327 was completed on <br />(List all amendments. Use space below if needed.) <br />iAagreementsVormslfarm - agreement termination form _golden rod.doc <br />C©TC Office Use Only <br />C 2,C)L"L <br />City ®t soma Ana <br />JAN I 1 2024 <br />City Clerk's Office <br />l and final payment has been made. <br />Department: e ;�� <br />Phone/Ext.: <br />Signature: <br />Date: -7 13 ?/S <br />