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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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />C <br />itV Of Santa A <br />JAN 110M <br />City Clerk's Office <br />- <br />Id <br />agreement with Zoo ' , t LA)&,V—O( <br />No.-0-12 was completed an +� and final payment has been made. <br />(List all -amendments. Use space below if needed) , <br />Department: V <br />Phone/Ext.: X62.U5 <br />Signature: <br />rt <br />Date: <br />Y <br />AagreementsVorms�form - agreement termination form_gofdenrod.doc <br />