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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amendments (if any) are no longer in effect.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 <br />No. <br />(List all amendments. <br />COTC Office use Onl <br />CRY of Same Ana <br />City Clerk's Cffte <br />;ts Serutces-�vwlAbun of Orc,nr�2 (ovn�h�-c�ha. <br />A-9022-092-06 <br />was completed on <br />Use space below if needed) <br />lagreementslforms'tiform - agreement termination form—goldenrod.doc <br />c.evl-+t' 7 <br />and final payment has been made. <br />Department: <br />Phone/Ext.: �! <br />Signature: <br />Date: &-A <br />