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�a <br />City 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amendments (if any) are no longer in effect.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 />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 't <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 vmww,WVM,:�- <br />CCTC Office Use Onty <br />City of Santa Ana <br />City Clerk's Office <br />No. 202 040 was completed on ) '` and final payment has been made. <br />(List aH amendments. Use space below if needed.) <br />Department: C.111)fx <br />Phone/Exf.: <br />Signature: <br />Date: <br />i.lagreementsVormslform- agreement termination form_goldenrod.doc <br />