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City of Santa Ana <br />�.E. 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amendments (if any) are no longer in effect.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 1 <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 ► Aar Ary' 4fr25t <br />COTC Office Use Only <br />No. N-2021-114 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 0DA /A(t5 ��t11(Pi <br />Phone/Ext.: <br />Signature: I �� LApl� U�— <br />Date: (Q 301W-1-1 — <br />ragreements formsform- agreement terminatian form_ goldenrcddac <br />