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City of Santa Nna <br />Clerk of the Cc._acil <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amendments (if any) are no longer in effect.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 grgnt 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 />A-2020-043 15 <br />COTC Office Use On <br />FiNq CITY CLERK <br />? 133'23 PM3:5 <br />eialhbwY�'Grw-A _ C � n-r'c r <br />No. A was completed on �7 -i and final payment has been made. <br />(List aff amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />1:lagreementsVormsVorm- agreement termination form_goldenrod.doc <br />