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City of Santa Ana <br />- }Yx Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />op p <br />Please complete this form in its entirety when the attached agreement ar°d a <br />amendments (if any) are no longer in effect. <br />Dote: 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 agreements) 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 />A-2(]22-1�33-Q1 <br />N©. was completed on <br />(List all amendments. Use space below if needed.) <br />il�agreementsVormsVorm- agreement termination form —golden rod. doc <br />COTC Office Use Only <br />C 2oZ3 <br />C- <br />Y CLERK <br />'. and final payment has been made. <br />De part m en t: ��'LI �" l G--11 IV� ,� t�-�- <br />l,e <br />Phone/Ext.: f 5 L1 �i3 <br />Signature: <br />Date: /. <br />