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City of Santa Ana <br />*# Clerk of the Council <br />t) <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amendments (if any) are no longer in effect.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 4— <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with4<�- c7F; — <br />f <br />CoTC office Use Oniy <br />C2-0 `-, <br />City of Santa Ana <br />City Clerk's Office <br />N-2022-08 ( <br />No. _ _ was completed on �� ��� and final payment has been made.. <br />(List all ame► irr �s. Use pace below if needed.) <br />-IDIL (.0 <br />6agreementslformslform - agreement termination form—goldenrod.doc <br />Department: C b /--"\ <br />Phone/Ext.: 53 6 5 <br />Signature: <br />Date: 2 77 <br />