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City of Santa Ana <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Off Ice Use Oniv <br />AF UHF COIJI B, <br />9 s2 If oo,3:00 <br />The agreement with t d i (11M1 iL %AA6nt-,7r <br />No N-2019-214-01 was completed on (Axli and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.: <br />Signature: Cat. <br />Date: <br />i'dagreemenls4ormslform agreement termination form_goldenrod.doc <br />