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City of Santa Ana <br />` Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use OnIY <br />ANTANTA ANA CITY CUE R.K. <br />A 01 0 1 2. 3 P H 2 : <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amendments (if any) are no longer in effect.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 farm. <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 />C 2 <br />The agreement with lw;\s mV 9w,A keyOC r �Y�C. <br />No. Z -,- was completed on t and final payment has been made. <br />(List all amendments. Use space below if needed <br />Department: W-0 <br />Phone/Ext.: <br />Signature: <br />L: agreementslformslform - agreement termination form—goldenrod.doc <br />