Attachment I
DOA 710

Effective for year beginning
July 1, ________

Verification of Compliance
Senior Center Long-Term Obligations

Applicable for the following:

1)	All senior centers receiving federal and/or state funds for renovations or purchase of equipment and;

2)	All senior centers receiving state funds for construction or acquisition.

This notice shall be filed with the area agency on aging administrator no later than July 31 for each year of the 10 year long-term obligation period for renovation and equipment purchases and 20 years for construction.

As specified in Section 312 of the Older Americans Act, as amended the 

				(Name of Senior Center)

is owned by 												
				(Name of Owner)

who is a public or private nonprofit agency or organization and continues to be utilized as a multipurpose senior center, as defined in Section 302(10) of the Older Americans Act.

												
						Signature

						Typed Name

						Title

						Date