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City of Santa Ana eaTG Office Use Only <br />' Clerk of the Council <br />CZ 02, <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amendments (if any) are no longer in effect.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 farm. kN'T ANA G] TY PMERK <br />flif Q 523 Pm9 • ,a? <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 />�1 <br />No. N-2021-229 was completed on <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />i:tagreementsVorms',fcrrn - agreement termination form_goldenrod.doc <br />and final payment has been made. <br />ivy s- <br />