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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 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amendments (if any) are no longer in effect.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 with <br />^, Ve- <br />U rv" <br />COTC Office Use Only <br />C2,0Z <br />City of Santa Ans <br />JAN 11 2024 <br />City Clerk's Of!C6' <br />N-2022-115 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: (_ <br />Phone/Ext.: <br />Signature: <br />Date=1��„� <br />i:lagreerrentsVormslform - agreement termination fong olden rod. doo <br />