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City of Santa Ana <br />Clerk of the COL it <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amendments (if any) are no longer in effect.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 ant retention requirements <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) a permanent record? Yes No _ SP T <br />as <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 <br />A-2021-068-07 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />0agreementsvtormofami agreement termination form goldenrod doc <br />COTC Office Use Only <br />PNq CITY CLERK <br />)3'r) PM"3:46 <br />\ I IQ I?/� and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />CU - <br />hS�I <br />IQ1gIP-- <br />