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City of Santa Ana <br />City Clerk 5� <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amendments (if any) are no longer in effect. ,_: �cs <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 />No. /y -Zo1q — d 54 was completed on ZO 2®i and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />COTC Office Use Only <br />OF THE COUNCLI <br />r 10'23 A49 30 <br />Department <br />Phone/Ext.: <br />GO I c <br />5z�:)S <br />Signature: <br />Date: � 10�2Z,:3 c;ci <br />