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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 /> TrPEOF MENT ? CASH <br /> PAYMENT b. '7C"the applicable box <br /> (See instructions on back) REQUESTED ®ACCRUAL <br /> (ZI FINAL ? PARTIAL <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 HAF041 M03 2 <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 December 18, 2004. June 30, 2005 <br /> <br /> j 9. RECIPIENT ORGANIZATION 10. PAYEE (When: check Is to be sent if different than Item 9J <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) (oJ <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> Wetlands Vegetation TOTAL <br /> a. Total program (As of date) <br /> outia stodate $ 122,000.00 $ $ $ 122,000.00 <br /> b. Less: Cumulative ro ram income 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> tine a) 122,000.00 0.00 0.00 122,000.00 <br /> d. Estimated net cash outlays for advance <br /> eriod 0.00 <br /> e. Total (Sum oflines c & d) 122,000.00 0.00 0.00 122,000.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 122,000.00 122,000.00 <br /> h. Federal a menu reviousl requested 109,474.21 109,474.21 <br /> i. Federal share now requested (Line g 12,525.79 0.00 0.00 12,525.79 <br /> minus line h) <br /> J• 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 outla s that will be made durin eriod covered b the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash on hand as of be innin of advance eriod <br /> c. Amount re nested (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 />