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City of San 'Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />'lease complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Nate: 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 farm to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />an Sou aS vjus o � <br />No. A-2021-107-ni A 1.. <br />(List all amendments. <br />was completed and <br />Use space below if needed.) <br />legreementslformsVorm - agreement termination form,goldenrod.doo <br />Department: <br />COTC Office Use Oniy <br />C z0-23 <br />City of Santa Any <br />JAN 11 2024 <br />city Clerk's Office <br />3 OL <br />and final payment has been made. <br />Phone/Ext.: <br />Signature: <br />Date: <br />