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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348-0004 ~ 2 PAGES <br /> a. '7C" one or both boxes 2. BASIS OF REQUEST <br /> OR REIMB R E <br /> U S MENT ADVANCE REIMBURSE- <br /> TYPE OF ? ® MENT ? CASH <br /> PAYMENT b. 'x" the applicable box <br /> (See insfrucffons on back) REQUESTED l~ FINAL ? PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4. FEDERAL GRANTOR OTHER 5. PARTIAL PAYMEM 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 HEF061M12 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 July 1, 2006 October 1, 2006 <br /> 9. RECIPIENT ORGANIZATION ~ 10. PAYEE (Where Check !5 to be sent If di/tefent than item 9) <br /> Name: City of Eugene Name: <br /> <br /> I <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 /> (a) {b) (c) <br /> PROGRAMS/FUNCTIONSJACTIVITIES ? <br /> Wetlands Oversight TOTAL <br /> a. Total program (As of date) $ 12 000.00 $ $ $ 12000,00 <br /> outla to date <br /> b. Less: Cumulative rogram income 0.00 0.00 <br /> c. Net program outlays (Line a minus 12,000.00 0.00 0.00 ~ 2,000.00 <br /> line b) <br /> d. Estimated net cash outlays for advance 0.00 <br /> rind <br /> e. Total (Sum otlines c & d) 12,000.00 0.00 0.00 12,000.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount an line a 12,000.00 12,000.00 <br /> h. Federal a ents reviousl re nested 6,000.00' 6,000.00 <br /> i. Federal share now requested (Line g 6,000.00 0.00 0.00 6,000.00 <br /> minus line b) <br /> L Advances required by <br /> 1st mgnth 0.00 <br /> month, when requested <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 that will be made durin eriod covered b the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash on hand as of innin of advance eriod <br /> $ 0.00 <br /> c. Amount re Lasted (Una 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 />