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r" <br />City of Santa Ana <br />City Clerk <br />AGREEMENT TERMINATION FORM S1%� <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amendments (if any) are no longer in effect.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-2023-085 t <br />No. was completed on <br />(List all amendments. Use space below N needed.) <br />i1agreemei-Wformslform - agreement termination form_goldenrod,doc <br />COTC Office Use Only <br />City of Santa Ana <br />City Clerk's Office <br />e d L <br />G <br />km ae, <br />and final has been made. <br />payment <br />Department: <br />Phone/Ext.: <br />Signature: <br />W/ <br />Date: <br />i 1 0 / `y3 <br />