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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 al <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amendments (if any) are no longer in effect.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 <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 L-a-t-)M 111 <br />A-2022-033-03 r� <br />No.ci.I-�`�- <br />Gist ail amendments. <br />was comp e e on <br />Use space below if needed.] <br />iAagreementsWormsVorm - agreement termination form_goldenrod.doc <br />Department: <br />COT'C Office Use Only <br />C 2023 <br />city 01 Santa Ana <br />JAN 112014 <br />city clerws Cff c <br />and final payment has been made. <br />VtA D <br />Phone/Ext.: is L�LL$ <br />Signature:qa'kA-P4� <br />Date: l <br />