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.OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE o34s-ooo4 - 1 2 PAGES <br /> a. ~C"one orboth boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT' ?ADVANCe ® REIMBURSE- <br /> TYPE OF MENT ? CASH <br /> PAYMENT b. '7C"the applicable box <br /> (See instructions 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 /> BYFEDERA[AGENCY <br /> U.S. Bureau of Land Management HEF031 M02 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 1536-0031-8601 October 1, 2003 September 30, 2004 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check Is t0 be sent!( difterent than item 9) <br /> Name: City of Eugene Name: ' <br /> Number Number <br /> and street: 777 Pearl Street and Street: <br /> City, State Eu ene, OR 97401 City, State <br /> and ZIP Code: g and ZIP Code: <br /> COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMS/FUN.CTIONS/ACTIVITIES (a) (b) (c) <br /> October 1, 2004 TOTAL <br /> a. Total program (As of date) <br /> outia to date $ 14,500.00 $ $ $ 14,500.00 . <br /> b. less: cumulative ro ram income 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> line b) 14,500.00 0.00 0.00 14,500.00 <br /> d. Estimated net cash outlays for advance <br /> riod 0.00 <br /> e. Total (sum otlines c $ d) 14,500.00 0.00 0.00 14,500.00 <br /> f. Nan-Federal share of amount an line a 0.00 0.00 <br /> . Federal share of amount on Tine a 14;500.00 14,500.00 <br /> h. Federal ments reviousl r nested 0.00 0.00 <br /> i. Federal share now requested (Line g <br /> minus line h) 14,500.00 0.00 0.00 14,500.00 <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 that will 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 nested (Line a minus line b) $ 0.00 <br /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION. (Continued on Reverse) sTANDaRD FORM z~a <br /> (Rev. 7,9~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />