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City of Santa Ana <br />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amendments (if any) are no longer in effect.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 />Mote: 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 City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />Flores <br />k e,\ 0, V-1 A,-f 0 <br />Ili-2a23-14i <br />No. was completed on <br />(List all amendments. use space below if needed.) <br />jAegreementslforms'dorm - agreement termination form_goldenrod.doc <br />COTC Office Use Qnl <br />L- U12-E <br />City of Santa Are, <br />City Cleric's Office <br />and final payment has been made. <br />F <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: , <br />