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OMB APPROVAL NO. PAGE OF <br /> 0348-0004 1 2 PAGES <br /> REQUEST FOR ADVANCE a. x"one or both boxes 2. BASIS OFREOUEST <br /> OR REIMBURSEMENT ? ADVANCE ® REIMBURSE- <br /> TYPE of MENT ? CASH <br /> PAYMENT b. '7C" the 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 HAF041 M03 1 <br /> i <br /> 8. 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 March 26, 2004 December 17, 2004 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where checkls to be sentifdiflerentthan item 9) <br /> Name: City of Eugene Name: ' <br /> <br /> j 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 of date) $ 109 474.21 $ $ $ 109 474.21 <br /> outla s to date ~ , <br /> b. Less: Cumulative ro ram income 0.00 0.00 <br /> c. Net program outlays (Une a minus 109,474.21 0.00 0.00 109,474.21 <br /> line b) <br /> d. Estimated net cash outlays for advance <br /> eriod ~ 0.00 <br /> e. Total (Sum oflines c & d) 109,474.21 0.00 0.00 109,474.21 <br /> f. Non-Federal share of amount on line a O.OO O.OO <br /> g. Federal share of amount on line a 109,474.21 109,474.21 <br /> h. Federal a ments reviousl re uested 0.00 O.OO <br /> i. Federal share now requested (Line g 109,474.21 0:00 0.00 109,474.21 <br /> minus line h) <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 O.OO <br /> prescheduled advances 3rd month O.OO <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla s that will be made Burin 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 (Une a minus line b) $ O.OO <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 />