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OMB APPROVAL NO. PAGE OF <br /> 0348 -0004 1 I 2 PAGES <br /> REQUEST FOR ADVANCE a "X " one or both boxes 2 BASIS OF REQUEST <br /> OR REIMBURSEMENT 1. ❑ ADVANCE ® REIMBURSE - <br /> TYPE OF MENT ❑ CASH <br /> PAYMENT b "X" the applicable box <br /> (See instructions on back) REQUESTED <br /> VI FINAL ❑ PARTIAL ® ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4. FEDERAL GRANT OR OTHER 5. PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HAF061M13 1 <br /> 6. EMPLOYER IDENTIFICATION 7. RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER FROM (month day, year) TO (month, day, year) <br /> 93- 6002160 1536- 0031 -8601 July 1, 2007 November 15, 2007 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent if different than item 9) <br /> Name: City of Eugene Name: <br /> Number Number <br /> and Street: 777 Pearl Street and Street <br /> City, State City, State <br /> and ZIP Code: Eugene, OR 97401 and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS /ADVANCES REQUESTED <br /> (a) (b) (c) <br /> PROGRAMS /FUNCTIONS /ACTIVITIES ► <br /> Project Assistance TOTAL <br /> a. Total program (As of date) <br /> outlays to date $ 50,000.00 $ $ $ 50,000.00 <br /> b. Less: Cumulative program income 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> line b) 50,000.00 0.00 0.00 50,000.00 <br /> d. Estimated net cash outlays for advance 0.00 <br /> period <br /> e. Total (Sum of lines c & d) 50,000.00 0.00 0.00 50,000.00 <br /> f. Non - Federal share of amount on line e 0.00 0.00 <br /> g. Federal share of amount on line e 50,000.00 50,000.00 <br /> h. Federal payments previously requested 0.00 0.00 <br /> i. Federal share now requested (Line g <br /> minus line h) 50,000.00 0.00 0.00 50,000.00 <br /> i. Advances required by <br /> month, when requested 1st month 0.00 <br /> by Federal grantor <br /> agency for use in making 2nd month 0.00 <br /> prescheduled advances 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outlays that will be made during period covered by the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash on hand as of beginning of advance period <br /> c. Amount requested (Line a minus line b) $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev. 7 -97) <br /> Prescribed by OMB Circulars A -102 and A -110 <br />