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City of Santa Ana <br />-- Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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 farm to the Clerk of the Council Office (M-30). <br />Call 647-1 S20 if you have any questions. <br />The agreement with <br />No. <br />ravtcte , R <br />COTC office Use On <br />( I - �j,) 2 (--" <br />City of Santa Aria <br />JAN 11 202 <br />City Clerk's Office <br />N-2022-273 was completed on U 1 r and final payment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department <br />Phone/Ext.: <br />Signature: <br />©ate: <br />hagreemenisVormslform - agreement termination f©rm_goldenrod.doc <br />LI-1 1 d�01 <br />