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y City of Santa Ana <br />�r 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amendments (if any) are no longer in effect.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 />C©TC Office Use Oni <br />C 20?,3 <br />City of Santa Sena <br />JAN 11 2024 <br />City Clerk's Office <br />,1 <br />ID I <br />No. ,N-2023-011 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Exf.:- <br />Signature: <br />Date: <br />[AagreementsVorms1orm - agreement termination form—goidenrod.doc <br />