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City of Santa Ana COTC Office Use Only <br />Clerk of the Council <br />wx C 20 <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amendments (if any) are no longer in effect.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 al rant retention requirements QA <br />_= SNP ' LEzR <br />have been satisfied prior to signing the termination form. tE , s���pyiia, <br />E <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-] 520 if you have any questions. <br />The agreement with <br />��� �l i n tt�AW <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />6agraementslformslform - agreement termination form —goldenrod doe <br />and final payment has been made. <br />Department: <br />Phone/Ext.:�►r <br />Signature: <br />Date:; _ <br />