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City of Santa Ana <br />40 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amendments (if any) are no longer in effect.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 />Nate; 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 />The agreement with <br />No. was completed on <br />("List all amendments. Use space below if needed.) <br />i:lagreementVormslform - agreement termination form_goldenrod.doc <br />COTc Office Use Only <br />C20 <br />tv of Santa Amy <br />.BAN 11 1024 <br />-ty Clerk' Office <br />and final payment has been made. <br />ZN <br />Department:1 <br />Phone/Ext.: <br />Signature: x <br />Date: <br />