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,. City of Santa Ana <br />City Clerk <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amendments (if any) are no longer in effect.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 City Clerk's Office (M--30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />6 <br />No. N-2023-082 was completed on <br />(List allamendments. Use space below if needed.) <br />iAagreementsVormslform - agreement termination form—goldenrod.doc <br />COT _Office Use Only <br />C 2oZ'; <br />atv of Santa Ana <br />,City Clerk's Office <br />and final payment has been made. <br />Department: <br />Phone/Ext.: XL" <br />Signature: <br />Date:j <br />