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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amendments (if any) are no longer in effect.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 ali 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 />Cali 647-1520 if you have any questions. <br />The agreement with <br />COTC Office Use only <br />C 2-0 2,2.. <br />City of Santa Ana <br />City Clerk's Office <br />No, A- -10D - N 1 - ()5 was completed on �� b[ ��`�� � and final payment has been made. <br />(List all amendments. Use space below if needed.) � <br />Department: A <br />Phone/Ext.: <br />Signature: <br />Date: <br />lagreementslformslform - agreement termination form_goldenrod.doc <br />C� �LO�-- <br />