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City of Santa Ana <br />110 Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemenf 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amendments (if any) are no longer in effect.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 />s 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 />L;l�&t8kl <br />COTC Office Use Only <br />L - Lo�,L <br />ON of Santa Ana <br />City Clerk's Office <br />No. N-2022-023 was completed on �"� � � <br />P and final payment has been made.. <br />(List all amendments. Use space below if needed <br />Department: ' )A <br />Phone/Ext.: i3-y&5 <br />i <br />Signature:_ <br />Date:? ; <br />:�agreementslformslform - agreement termination form_goldenrod.doc <br />