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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amendments (if any) are no longer in effect.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 />s 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 �vicu Q ra G- <br />A-2922-992-05 <br />No. <br />(List all amendments. <br />was completed one <br />Use space below if needed.) <br />lagreementsWormsVorm - agreement termination form —goldenrod.dcc <br />COTC Office Use On <br />(A2-o2�3 <br />Ptv of Santa Aria <br />JAN 11 202 <br />City Qerkfs Once <br />and final payment has been made. <br />Department: A <br />Phone/Ext.: <br />P <br />Signature: <br />Date:' <br />