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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amendments (it any) are no longer in effect.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 />rW1 <br />l V1 l✓ . <br />GOTG Office Use Only <br />Cjt' of Santa Ana <br />City Clerk's Ctf CO <br />hJ-2a23-13U } <br />No. was completed on 11 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />hagreement0ormsVorm - agreement termination form^goldenrod.doc <br />