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City of Santa Ana City Clerk's Office Use Onl�r <br />�.� City Clerk <br />AGREEMENT TERMINATION FORM <br />My CLERK <br />Please complete this form in its entirety when the attached agreement and alRP;r' I'O <br />amendments (if any) are no longer in effect. ! y <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 />i <br />Return form to the City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with Vie nosvv,e e-- Pwv-e-,,('ca-1 Lds 4- Lz4rsys A-sSo,,A-clthis!'j, <br />No. N-2024-028 was completed on U2+202�- and final payment has been made. <br />(List all amendments. use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: (IL <br />Date: i�I4z�- <br />i;lagreemenlslformslform - agreement termination form—goldenrod.doc <br />