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City of Santa Ana <br />r City Clerk <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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 />Cali 647-6520 if you have any questions. <br />COTC Office Use Only <br />CZoZ3 <br />City of Santa Ana <br />JAIL 11 2024 <br />City Clerk's Office <br />a <br />The agreement with _f3afVit � ! C r��v V-t cy- ko( C kyt* � v- a I u <br />U <br />N-2023-108 was completed on �'�' payment No. p � �� -� and final a ment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />FITH M <br />L: agreementslformsVorm - agreement termination form—gotdenrod.dao <br />