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' OMB APPROVAL NO. ~ ~ PAGE ~ OF <br /> 0348-0004 1 2 PAGES <br /> REQUEST FOR ADVAN CE a: '?C"one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? AwANCE ® REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. '7l"ahe applicable box <br /> (See instrucfions on back) REQUESTED m 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 HEF051M10 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-OD31-8601 September 13, 2005 June 30, 2006 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent 1(dif(erent 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 /> Botanical Assistance TOTAL <br /> a. Total program (As ofdate) $ 14.,500.00 $ $ $ 14,500.00 <br /> outla to date <br /> b. Less: Cumulative ro ram income 0.00 0.00 <br /> c. Net program outlays (Line a minus 14,500.00 0.00 0.00 14,500.00 <br /> line b) <br /> d. Estimated net cash outlays for advance O.OO <br /> eriod <br /> e. Total (sum oflines c & d) 14,500.00 0.00 0.00 14,500.00 <br /> f. Non-Federal share of amount on line a O.OO O.OO <br /> . Federal share of amount on line a 14,500..00 14,500.00 <br /> h. Federal a ments reviousl re nested 0.00 0.00 <br /> i. Federal share now requested (Line g 14.,500.00 0.00 0.00 14,500.00 <br /> minus tine h) <br /> <br /> J• Advances required by <br /> month, when requested 1st month O.OO <br /> by Federal grantor 0.00 <br /> agency for use in making 2nd month <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 /> $ 0.00 <br /> c: Amount re nested Line a minus tine b <br /> AUTHORIZED FOR LOCAL. REPRODUCTION {Continued on Reverse) sTANDARD FORM zoo (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />