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i <br /> OMB APPROVAL NO. PAGE OF <br /> 0348-0004 1 2 PAGES <br /> REQUEST FOR ADVANCE <br /> a. 'x" one orboth boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ?ADVANCE ® REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. '7C" the applrcabte box <br /> (See instructions on back) REQUESTED ? FINAL ®PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGAN2ATIONAL ELEMENT TO 4. FEDERAL GRANT OR OTHER 5. PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERALAOENCY <br /> U.S. Bureau of Land Management HAF041 M05 1 <br /> <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 September 23, 2004 June 30, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check Is to be sent Jf different than Item 9) <br /> Name: City of Eugene Name: <br /> Number Number <br /> and Street: 777 Pearl Street and Street: <br /> CJty, State City, State <br /> and z~P code: Eugene, OR 97401 <br /> and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMS/FUNCTIONS/ACTIVITIES (a) (b) (c) <br /> Native Plant Materials TOTAL <br /> a. Total program (as orders) <br /> outla to date $ 26,453.83 $ $ $ 26,453.83 . <br /> b. Less: Cumulative ro ram income 0.00 <br /> 0. <br /> 00 <br /> c. Net pr utiays {Line a minus <br /> line b) 26,453.83 0.00 0.00 26,453.83 <br /> d. Estimated net cash outlays for advance <br /> r(od <br /> 0.00 <br /> e. Total (Sum oflines c & d) 26,453.83 0.00 0.00 26,453.83 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 26,453.83 26,453.83 <br /> h. Federal a ments reviousl re uested 0.00 0.00 <br /> i. Federal share now requested (Line g <br /> minus line h) ~ 26,453.83 0.00 0.00 26,453.83 <br /> j• Advances required by <br /> month, when requested 1st month 0.00 <br /> by Federal grantor <br /> agency for use in making 2nd month 0.00 <br /> prescheduled advances <br /> 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla s thatwill 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 uested (Line a minus line b $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) srANDaRO FORM spa (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />