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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amendments (iany) are no longer in effect. <br />Nate: If your agreement is grant related, please ensure that ail 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. N—?j)-n — _ was completed on <br />{List al! amendments. Use space below if needed.) <br />iAagreementsVornnAorm - agreement termination form—goldenrod.doc <br />iCOTC Office Use Oniy <br />city of Santa Ana <br />,City Clerk's Office <br />and final payment has been made. <br />f <br />Department: <br />Phone/Ext.: <br />.Signature: <br />Date: <br />