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City of Santa Ana COTC Office Use Onl <br />City Clerk <br />G" LO Zv <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <br />amendments fief any) are no longer in effect.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-2023-159 p � � �� payment No. was completed on and final a ment has been made. <br />{List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />VagreementsVformsVorm - agfeement termination form --goldenrod doc <br />