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City of Santa Ana <br />1 City Clerk <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amendments (if any) are no longer in effect.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 farm. <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />t <br />N-2023-107 <br />No. was completed on <br />{List all amendments. Use space below if needed.) <br />iAagreementstiformslform - agreement termination form_goldenrod.doc <br />coTc Office use on�v <br />G-� zon <br />of Santa Ana <br />1ty Clews Office <br />and final payment has been made. <br />Department: t' <br />Phone/Ext.:� l <br />Signature: <br />Date: <br />