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City of Santa Ana <br />�F W <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amendments (if any) are no longer in effect.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 />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 />U- U)23 <br />The agreement with V �'1 �• 1 L-L <br />N-2023-269 <br />No. was completed on Land final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.:��v✓{7,L <br />Signature: <br />Date: j-� <br />i:lagreementslformslform - agreement termination formgoldenrod.doc <br />