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City of Santa Ana <br />4 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amendments (if any) are no longer in effect.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 form, <br />Is the agreement(s) a permanent record? Yes No <br />Refurn form to the City Clerk's Office (M-30) . <br />Call 647-6520 if you have any questions. <br />The agreement with r 1k <br />COTC office Use only <br />V , Lo L3 <br />lty of Santa Ana <br />JAN 1120h <br />City Clerk's Office, <br />N-2023-188 r, <br />No. was completed on L and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: d <br />Phone/Ext.: ! 'vs <br />Signature: <br />Date: <br />MagreementsVormsftrm - agreement termination form_goldenrod.doc <br />