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City of Santa Ana <br />Clerk of the Council <br />ti <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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. <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30) . <br />Cali 647-1520 if you have any questions. <br />The agreement with FYI rS M►AIIIOA It S I FYI G , <br />N-2022-028 <br />No. <br />(List all amendments. <br />was completed on <br />Use space below if needed.) <br />I: lagreemenfsVormsVorm - agreement termination fonm_goldenrod.doc <br />COFC Office Use only <br />C Zo Z2— <br />City of Santa And' <br />City lark's Office <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />bs- <br />Signature: <br />Date: <br />