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City Clerk's Office Use Only <br />7 <br />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amendments (it any) are no longer in effect.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 Wo UM L61 I Drown Q aloco, U lfum (7 I(0 r R, <br />N-2Q23-244 No. was completed on L,7 V and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />r. r <br />Phone/Ext.: As <br />Signature: <br />Date: <br />I agreementOormslform - agreement lermination form_goldenrod.doc <br />