Attachment II
DOA-711

Notice of Record - Senior Center Reversionary Interest
Units of Local Government

This is to serve as notice to all potential sellers, purchasers, transferors and recipients of a transfer of the real property described below as to the Federal Government's reversionary interest as set forth in Section 312 of the Older Americans Act of 1965, as amended, 42 U.S.C. 303b, which have arisen as a result of 

(Senior Center Sponsoring Agency)

receipt and use of Department of Health and Human Service's grant funds in connection with the purchase or construction of said property.  The property to which this notice is applicable is

(Address)

and identified as Parcel 										
(Insert Appropriate Number(s)

in the books and records of the Register of Deeds for 

 					County, North Carolina.  Said
	(County Name)

real property is also described as:									

(Insert Description Provided in Survey)

Further information as to the Federal Government's interest referred to above can be obtained from 											

(Name of Agency)

(Address of Area Agency on Aging)

Attachment II
DOA-711

											
(Indicate County/Municipality)

				By							 (Signature)
(Indicate Chairman, Board of
Commissioners or Mayor)

Attest: 					 (Signature)
	(Indicate Clerk, County Board
	of Commissioners or Town or
	City Clerk)

					(Notary Seal)