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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATM 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amendments (if any) are no longer in effect.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 />No. N-2022-a 18 was completed on <br />(List all amendments. Use space below if needed.) <br />i-AagreementsVormsWorm - agreement termination form_goidenrod.doc <br />CfJTC Dff3ce Use �nlY <br />C 2-02,� <br />City of Sang Ana <br />JAN 112024 <br />City Clerk's Office <br />1'2)t 17-1 and final payment has been made. <br />Department: C- VA <br />Phone/Ext.: f <br />Signature: <br />Date: •� <br />