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City of Santa Ana <br />fi 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amendments (if any) are no longer in effect.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 />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 agreement(s) a permanent record? Yes No <br />Return form to the Cleric of the Council Office (M-30) . <br />Call 647-1520 if you have any questions. <br />The agreement with U d <br />1 <br />N-2022-100 _k:_14 �� <br />No. <br />(List all amendments. <br />was completed on <br />Use space below if needed <br />iAagreemeWsVormslform agreement termination form_goldenrod.doc <br />Department: <br />Phone/Ext.: <br />Signature: <br />GOiC ©ffice 115@ Dnly <br />C2-0 2,'2-- <br />City of Santa Ara. <br />JAM I i zw <br />City Clerk'"s Office, <br />and final payment has been made. <br />VI o <br />'x' <br />Date: _ 1 [1, 3 � <br />