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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE o34s-ooo4 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. '9C"the applicable box <br /> (See instructions on back) REQUESTED ? FINAL ? PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMEM TO 4. FEDERAL GRANTOR OTHER 5. PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED IDENTIFIING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY. <br /> U.S. Bureau of Land Management HEF041 M07 1 <br /> I <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 October 27, 2004 June 30, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be Sentif ddferent than item 9) <br /> i <br /> Name: City of Eugene Name: <br /> Number Number <br /> and street: 777 Pearl Street and Street: <br /> j <br /> City, State City, State <br /> and z~P code: Eugene, OR 97401 <br /> and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (a) (b) (c) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> Fuels reduction TOTAL <br /> a. Total program (As of date) $ 13 000.00 $ $ $ 13 000.00 <br /> outla to date ~ ~ , <br /> b. Less: cumulative rogram income 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> tine b) 13,000.00 0.00 0.00 13,000.00 <br /> d. Estimated net cash outlays for advance O.OO <br /> riod <br /> <br /> i e. Total (Sum oflines c & d) 13,000.00 0.00 0.00 13,000.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> g. Federal share of amount oh line a 13,000.00 13,000.00 <br /> h. Federal a ments reviously requested 0.00 O.OO <br /> i. Federal share now requested (Line g - <br /> minus tine b) - 13,000.00 0.00 0.00 13,000.00 <br /> 1• Advances required by <br /> month, when requested 1st month O.OO <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 eriod covered b the advance $ O.OO <br /> b. Less: Estimated balance of Federal cash on hand as of be innin of advance eriod - <br /> c. Amount re uested (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 /> _ _ <br /> <br />