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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE o34s-ooo4 - 1 2 PAGES <br /> a. 7C"one orboth boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? ADVANCE ®REIMBURSE- <br /> TYPEOF MENT ? CASH <br /> PAYMENT b. '7C"the applicable box <br /> (See instructions on back) REQUESTED ~ 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 HEF031 M03 ~ <br /> 6. 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 22, 2003 Se``ptember 30, 2004 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent ifdiffenant than item 9) <br /> Name: City of Eugene Name:. <br /> Number Number <br /> and Street: 777 Pearl Street and Street: <br /> ct~; state Eu ene, OR 97401 city, state <br /> and ZIP Code: g and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (aJ (b) (QI <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> October 1, 2004 TOTAL <br /> a. Total program (ASOtda:e) $ 18,071.47 $ $ $ 18 071.47 <br /> outla to date ~ <br /> b. Less: cumulative rogram income 0.00 0.00 <br /> a Net program outlays (Une a minus 18,071.47 0.00 0.00 18,071.47 <br /> Une b) <br /> d. Estimated net cash outlays for advance 0.00 <br /> riod <br /> e. Total (sum oP/ines c $ d) 18,071.47 0.00 0.00 18,071.47 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 18,071.47 18,071.47 <br /> h. Federal a ments reviousl re nested 0.00 0.00 <br /> i. Federal share novvrequested (Line g 1$,071.47 0.00 0.00 18,071.47 <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.OO <br /> prescheduled advances 3rd month O.OO <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla s that will be made Burin eriod covered b the advance $ O.OO <br /> b. Less: Estimated balance of Federal cash on hand as of be innin of advance eriod <br /> <br /> c. Amount re nested (Line a minus line b) $ 0.00 <br /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTaNOARO FORM 2~0 (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />