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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348=0004 1 2 PAGES <br /> a. '7Z"one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? AuvANCE ® REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. %C°theapplicable box <br /> (See instructions on back) REQUESTED QJ 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 HEF041 M04 1 <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 April 30, 2004 September 30, 2004 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check Is to be sent if difrerent than Item 9) <br /> Name: City. of Eugene Name: ' <br /> Number Number <br /> and street: 777 Pearl Street and street: <br /> city, state Eu aria, OR 97401 City, State <br /> and ZIP Code: g and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMSlFUNCTIONS/ACTIVITIES ? <br /> October 1, 2004 TOTAL <br /> a. Total program (Aso(dateJ $ 24,500.00 $ $ $ 24 500.00 <br /> outla s to date <br /> b. Less: Cumulative ro ram income 0.00 ~ 0.00 <br /> c. Net program outlays (Una a minus <br /> line bJ 24;500.00 0.00 0.00 24,500.00 <br /> d. Estimated net cash outlays for advance <br /> eriod 0.00 ~ <br /> e. Total (sum otlines c & d) 24,500.00 0.00 0.00 24,500.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on Tine a 24,500.00 24,500.00 <br /> h. Federal a merits reviousl requested 0.00 ~ 0..00 <br /> i. Federal share now requested (Line g 24.,500.00 0.00 0.00 24,500.00 <br /> minus line h) <br /> 1~ Advances required by <br /> month, when requested 1st month 0.00 <br /> by Federal grantor <br /> agency for use in making ~ 2nd month O.OQ <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 Burin 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 /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued an Reverse) sTANOARO FORM zoo (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />