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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amendments (if any) are no longer in effect.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 />Note: It 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 />Gity Cierk's pffice Use Oniy <br />The agreement with ,O1-1no � Prewri ;�,n (�� � ) (n �efjt I-tij <br />N-2023-245 a we re. <br />No. was completed on % , " and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: LA L9 <br />Phone/Ext.: <br />Signature: <br />Date: <br />i:lagreementsVormslform - agreement termination form_goldenrod.doc <br />