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City of yarn 'I Ana <br />Clerk of the Louncil <br />Ir 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amendments (if any) are no longer in effect.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 it you have any questions. <br />ICOTC Office Use Only <br />� z�23 <br />City of Santa Ann, <br />JAM 11 20 <br />city Clork's Office, <br />The agreement with L 6OAKUhf �L 14 Gr 6v�. PC r e�3 6a- <2S 6 <br />JA <br />A-2021-107-07 <br />No. - was completed on 9 2,14and final payment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department: <br />Phone/Exf.: <br />Signature: <br />Date: <br />Aagreements',formsWorm - agreement termination farm—goldenrod.doc <br />