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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amendments (if any) are no longer in effect.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 />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 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.-��';�-5 was completed on��i <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.-. <br />Signature: <br />Date: <br />lanrPPmP.nt,JnrmsWorm - aareement termination form_goldenrod.doc <br />CQTC Office ll e Only <br />city of Santo Ana <br />City Glory's Offloo <br />and final payment has been made. <br />