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City of Santa Ana <br />°;-- Clerk of the Council <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amendments (if any) are no longer in effect.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 />Na, IV-2022-003 was completed on .= <br />(List all amendments. Use space below if needed.) <br />i:�agreemenisvormstform - agreement terminati©r form_pidenrod.doc <br />COTC office Use only <br />City of santa Ana <br />JAN 117024 <br />City Clerk's OiflW <br />and final payment has been made. <br />Department: d' <br />sr <br />Phone/Ext.: V` <br />Signature: <br />Date: w ' L <br />