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City at Santa Ana <br />� City Clerk. <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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 />The agreement with <br />N-2023_254 <br />No. <br />(List all amendments. <br />was completed on <br />Use space below if needed.) <br />i:lagreementslformstform - agreement termination form_goldenrod.doc <br />critj <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Cify Clerk's Office Use ani <br />City of Santa Dina <br />JAN 11 2024 <br />City Clerk's Office <br />and final payment has been made. <br />