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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM J/ <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. °E <br />�v <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 />The agreement with Vkty 'V-,,' 7ucy-� <br />No. N-2020-172 was completed on <br />(List all amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />COTC Office Use Only <br />OF NE COUNCIL <br />19'22 AM1 f :21 <br />and final payment has been made. <br />Date: <br />rlagreementslformelform - agreement termination form—goldenrod.doc <br />