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City of Santa Ana <br />A. <br />Clerk of the Council <br />::ter <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amendments (if any) are no longer in effect.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 farm to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />COMMuni-i-I <br />A R—A ��� V-CV1 10 4- D V-4 <br />No. '�`-�-�-� was completed on C1 ';. � <br />(List all amendments. Use space below if needed.) <br />i:lagreementsbrmsl#orm - agreement termination form_goldenrod.doc <br />Department: <br />COTC Office Use Only <br />( ?-Q Z; <br />City of Santa Ana <br />City Clerk's Office <br />and final payment has been made. <br />Phone/Ext.: <br />Signature: <br />Date: 77 <br />