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Clity 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amendments (if any) are no longer in effect.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 x <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 />/V\a. rf <br />N-2022-033 <br />No. was completed on <br />(Last all amendments. Use space ,below if needed.) <br />9:1,agreernentslfcrrns4orm - agreement termination €orrn_galdenrod.doc <br />COTC Office Use Only <br />C 2022- <br />City Of Saute Arse <br />City Clerk's Office <br />!`r and final payment has been made. <br />Department: C 01;; <br />Phone/Exf.: <br />Signature: r` <br />Date: C:�P'. <br />