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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348-0004 1 2 PAGES <br /> a. '7C"one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? ADVANCe ® REIMBURSE- <br /> TYPE OF MENT ? CASH <br /> PAYMENT b. '7C" 1he applicable box <br /> (See instructions on back) REQUESTED ~ FINAL ? PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4. FEDERAL GRANTOR 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 HEF041 M05 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 June 7, 2004 December 17, 2004 <br /> 9. RECIPIENT ORGANIZATION _ 10. PAYEE (WhelE Ch2Ck IS t0 be SB/lf If dlffElLnt fhaA lteRl 9) <br /> Name: Clty Of Eugene Name: <br /> Number Number <br /> and Street: 777 Pearl Street and Street: <br /> city, state Eu ene, OR 97401 city, State <br /> and ZIP Code: g and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> la) (b) (c) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> December 17, 2004 TOTAL <br /> a. Total program (As ofdate) $ 5'000.00 ~ $ $ 5 000.00 <br /> outlays to date , <br /> b. less: Cumulative ro ram income 0.00 O.OO <br /> c. Net program outlays (Line a minus <br /> line b) 5,000.00 0.00 0.00 5,000.00 <br /> d. Estimated net cash outlays for advance <br /> eriod 0.00 <br /> e. Total (sum otlines c & d) 5,000.00 0.00 0.00 5,000.00 <br /> f. Non-Federal share of amount on line a O.OO O.OO <br /> . Federal share of amount on line a 5,000:00 5,000.00 <br /> h. Federal pa ments reviousl re uested O.OO 0.00 <br /> i. Federal share now requested (Line g <br /> minus line h) 5,000.00 .0.00 0.00 5,000.00 <br /> 1• Advances required by <br /> month, when requested 1st month 0:00 <br /> by Federal grantor <br /> agency for use in making 2nd month O.OO <br /> prescheduled advances 3rd month O.OO <br /> 12• ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla that will be made Burin eriod covered by the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash an hand as of be innin of advance eriod <br /> <br /> c. Amount re nested (Line a minus line b) $ 0.00 <br /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION (COntinued On RBVerse) STANDARD FORM 270 (Rev. 7-97) <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> i <br /> i <br /> 1 <br /> _ <br /> <br />