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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE o34s-ooo4 1 2 PAGES <br /> a. 7C"one wboth boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? ADVANCE ® REIMBURSE- <br /> TYPE OF MENT ~ CASH <br /> PAYMEM 6. ~C"the applicable box <br /> (See instnrc6ons on back) REQUESTED m 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 M06 1 <br /> 6. EMPLOYER IDENTIFICATION 7. RECIPIENT'S ACCOUNT NUMBER 8. PERIOD COVERED BY THIS RE U <br /> Q EST <br /> NUMBER OR IDENTIFYING NUMBER FROM (month, day, year) TO (month, day, year) <br /> 93-6002160 1536-0031-8601 October 1, 2004 June 30, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent it diflelent than ffem 9J <br /> Name: City of Eugene Name: <br /> Number Number <br /> and Street: 777 Pearl Street and Street: <br /> city, stare 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 /> PROGRAMSlFUNCTIONS/ACTIVITIES ? <br /> Botanical Assistance TOTAL <br /> a. Total program (AS Of date) $ 14 500.00 $ $ $ 14,500.00 <br /> <br /> ' outia to date ~ <br /> b. Less: cumulative ro ram irx:ome 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> Gne b) 14,500.00 0.00 0.00 14,500.00 <br /> d. Estimated net cash outlays for advance <br /> rind 0.00 <br /> e. Totat {sum orGnes c a d) 14,500.00 0.00 0.00 14,500.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 14,500.00 14,500.00 <br /> h. Federal a eats reviousl requested ~ 0.00 Q,OO <br /> i. Federal share now requested (Line g <br /> minus line n) 14,500.00 0.00 0.00 14,500.00 <br /> J• Advances required by <br /> month, when requested 1st month O.OO <br /> by Federal grantor <br /> agency for use in making 2nd month 0.00 <br /> prescheduled advances 3rd month O.OO <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla that will 6e 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 riod <br /> c. Amount re nested (Llne a minus line b) $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTANDARO FoRta 2~0 (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />