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OMB APPROVAL NO. ~ PAGE OF <br /> REQUEST FOR ADVANCE o348-0004 1 2 PAGES <br /> a. 9C"one orboth boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? ADVANCE ® REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. 9C"the applicable box <br /> (See instructions on back) REquESrED ®ACCRUAL <br /> m FINAL ? PARTIAL <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 HEF031M03 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 1536-0031-8609 October 1, 2004 January 7, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check Is to be sent /f different than item 9) <br /> Name: City of Eugene Name: <br /> Number Number <br /> and street: 777 Pearl Street and Street: <br /> City, State City, State <br /> and ZIP Code: Eugene, OR 97401 and ztP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> TOTAL <br /> January 7, 2005 <br /> a. Total program (AS Of dare) $ 23 000.00 $ $ $ 23 000.00 <br /> outla s to date + + <br /> b. Less: cumulative ro ram income 0.00 0.00 <br /> c. Net program outlays (Line a minus 23,000.00 0.00. 0.00 23,000.00 <br /> line b) <br /> d. Estimated net cash outlays for advance 0.00 <br /> eriod <br /> e. Total (sum oflines c & ~ 23,000.00 0.00 0.00 23,000.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 23,000.00 23,000.00 <br /> h. Federal a menu reviousl re uested 18,071.47 18,071.47 <br /> i. Federal share nowfequested-(Line g <br /> minus tine b) 4,928.53 0.00 0.00 4,928.53 <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 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outlays that will be made Burin eriod covered by the advance $ 0.00 , <br /> b. Less: Estimated balance of Federal cash on hand as of be innin of advance eriod <br /> $ 0.00 <br /> c. Amount re uested (Line a minus line b) <br /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTANDARD FORM 2~0 (Rev. ~-s7) <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />