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City of Santa Ana <br />Clerk of the Council <br />.v. <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amendments (if any) are no longer in effect.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 <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 K% d &ih- L- , I ! i' m yv, <br />No. A-zozz--oq-7 <br />was completed on <br />(List all amendments. Use space below if needed.) <br />0agreementskmnsftrm - agreement termination form_goldenrcd.doc <br />COTC Office Use ON <br />c2-0 2.2, <br />CjtV of jayita <br />JAB 1 1 2 <br />ciw <br />and final payment has been made. <br />Department: L"� <br />Phone/Ext.: Los - <br />Signature: <br />r <br />Date:" <br />