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City of Santa Ana <br />t City Clerk <br />AGREEMENT TERMINATION FORM <br />Use Only <br />Is <br />A <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amendments (if any) are no longer in effect.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-2023-083 <br />No. <br />(List all amendments. <br />was completed on -LQM(�__ <br />Use space below if needed.) <br />i'.lagreementsWormslform - agreement termination form_goldemod.doc <br />City of Santa Ana <br />JUL 06 2023 <br />City Clerk's Office <br />and final payment has been made. <br />Department: P ► —c s I J <br />Phone/Ext.: `1AA I <br />Signature: <br />Date: �3 <br />