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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348-0004 1 2 PAGES <br /> a. one ar both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ?ADVANCE 0 REIMBURSE- <br /> TYPE OF MENT ? CASH <br /> ' ~ ~ PAYMENT b. fhe applicable box <br /> (See in§tructions on back) RE~ESTEO ? FINAL 0 PARTIAL ®ACCRUAL <br /> ~?3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4. FEDERAL GRANTOR OTHER 5. PARTIAL PAYMENT REQUEST ' <br /> WH{CH THIS REPp,RT IS SUBMITTED ~ IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HEF051,M08 2 <br /> s. EMPLOYER IDENTIFICATIOtJ 7 REGPIENT's ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> NUMBER ~ ~ OR TDE'NrIFI'1NG NUMBER FROM (monk, <br /> ~Y ~ TO (rnorHh, day, year] <br /> `93-6002160 1536-0031-8601 September 1, 2005 December 31, 2006 <br /> 9. RECIPIENT OF2GANPI,TION ~ 10. PAYEE (IMlef@ d10Ck IS (U be Setif If dfierent than IteR19) <br /> Name: City~f Eugene Name: <br /> Number <br /> and Street.' 777~1?eafl Street and Street: <br /> Cily, State Eu err Cily, State <br /> and ZIP Code: 9 @, OR '97401 and ZIP Code: <br /> 11. COMPUTATION C1F AMOUNT OF REIMBURSEMENTSLADVANCES REQUESTED <br /> F..... <br /> PROGRAMS/FUNCTIONS/ACTIVITIES <br /> ~ ` Engineering Construction TOTAL <br /> a. Total program (As ddafe) $ 12 237.50 $ 3 876.00 $ ~ $ 16 113.50 <br /> outla to date ~ , <br /> b. Less: Cumulative ram income 0.00 0.00 0.00 0.00 <br /> c. Net.program outlays (Line a mrnnus <br /> Nne b) 12,237.50 3,876.00 0.00 16,113.50 <br /> d: Estimated net cash outlays for advance... - <br /> 0 00 <br /> e. Total (Sum ofines c & d) 12,237.50 3,876.00 0.00 16,113.50 <br /> f. Non-Federal share of amount on tine a 0.00 - 0.00 -.0.00. 0•.00 <br /> Federal share of amount on line a 12,237.50 3,876.00 16,113.50 <br /> h: Federal nts reviou nested .0.00 0.00 0.00 <br /> i. Federal share now requested (Line g <br /> minus 6ne Ir) 12,237.50 3,876.00 0.00 16,113.50 <br /> 1• Advances required by <br /> month, when requested 1 ~ month 0.00 <br /> by Federal grantor 2nd month 0.00 <br /> . agency for use in making <br /> prescheduled advances 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> ,a. Estimated Federal cash outla that will be made Burin 'od covered b the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash on hand as of beginnin of advance rind <br /> c. Amount r nested (Line a minus one b) $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUC ION (Continued o e srANOARO FORM 2TO (Rev. ~a~ <br /> Prescri by OMB Circulars A-102 and A-110 <br /> <br /> - _ - ~ . _ <br /> ~ ~ ~ a~ ~-1- F <br /> <br />