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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amendments (if any) are no longer in effect.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 />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 Tkam k r <br />No. _ N-2Q23-009 was completed on <br />(List all amendments. Use space below if needed.) ` <br />Department: <br />COTC Office Use C3nl <br />,2,102-3 <br />City of Sense Ana <br />JAN 11 Z02 <br />city Clerk's Office <br />and final payment has been made. <br />L116 <br />Phone/Ext.: � <br />Signature: <br />Date: <br />hagreements)formsVorm - agreement termination form_goldenrod.doc <br />