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City of Santa Ana <br />/s. <br />71,11 City Clerk �� I N <br />AGREEMENT TERMINATION FORM Ar- <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amendments (if any) are no longer in effect.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 City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />N-20i,2_na <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />i1agmementsVormWorm - agreement termination form_gaidenrod.doc <br />COTC Office Use Only <br />City of Santa Ana <br />-JUL 06 2023 <br />City Clerk's Office <br />SZ (LS andfinal <br />ypaayment has been made. <br />Department: P �� la <br />Phone/Ext.: Lwj <br />Signature: SIG <br />Date: <br />