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GOTc Office Use Only <br />City of Santa Ana <br />'5 <br />�.�► -� Clerk of the Council <br />"J� C <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amendments (if any) are no longer in effect.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 <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 />�C <br />No. N-202 -187 was completed on <br />(List all amendments. Use space below if needed.) <br />i &greementsVormsVarn} - agreement termination form_goldenrod.doc <br />S <br />Department: <br />JtRL JL19' 12 3 Pm5: IC-21 <br />IF� <br />and final payment has been made. <br />i11-7 <br />Phone/Ext.: <br />Xy- <br />Signature: <br />Date: 1 <br />