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City of Santa Ana <br />4r 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amendments (if any) are no longer in effect.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 />Return form to the City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />City Clerk's Office Use Only <br />The agreement with Q Mul eeoy i v (— UOlmt (00n'' Y <br />N-2023-248 <br />L- LO Z3 <br />No. was completed on ' <br />p ; � and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: J <br />Signature: <br />Date: <br />hagreementsWormslform - agreement termination form goldenrod doc <br />