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• OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 034$-0004 1 2 PAGES <br /> a. '7C"one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT 1~ ?AUVANCE ® REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. '7C"the applicable box . <br /> (See instructions on back) REQUESTED ~ FINAL ®PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGAN¢ATIONAL 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 HAF031 M02 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 /> j 93-6002160 1536-0031-8601 July 14, 2003 January 28, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE.(Where Check IS t0 be senf I/dlffemOt fhan Item 9) <br /> i <br /> Name: City Of Eugene Name: <br /> ~ Number Number <br /> and Street: 777 Pearl Street and Street: <br /> j City, State ~ City, State <br /> and ztP Code: Eugene, OR 97401 and zl~ Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> la) lb) lc) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ~ <br /> January 28, 2005 TOTAL <br /> a. Total program (Asordare) $ 758,877.92 $ $ $ 758 877.92 <br /> outla s to date , <br /> b. Less: Cumulative ro ram income- 0.00 0.00 <br /> c. Net.program outlays (Lane a minus <br /> tine b) 758,877.92 0.00 0.00 758,877.92 <br /> <br /> j d. Estimated net cash outlays for advance <br /> period 0.00 <br /> e. Total (sum oftines c & d) 758,877.92 0.00 0.00 758,877.92 <br /> f. Non-Federal share of amount on line a O.OO <br /> . Federal share of amount on line a 758,877.92 ~ 758,877.92 <br /> h. Federal pa ments reviousl re nested 0.00 0.00 <br /> i. Federal share now requested (Line g <br /> minus line n) 758,$77.92 0.00 0.00 758;877.92 <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 ~ 0.00 <br /> 72. 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 inning of advance period <br /> c. Amount re nested (Line a minus line b) $ O.OO <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTANOARO FORM zoo (Rev. ~-s7) <br /> Prescribed ~y OMB Circulars A-102 and A-110 <br /> _ <br /> <br />