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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 034$-0004 1 2 PAGES <br /> a. '7C" one a• both boxes 2. BASIS OFREQUESi <br /> OR REIMBURSEMENT ?ADVANCE ® REIMBURSE- <br /> TYPE OF MENT ? CASH <br /> PAYMENT 6. '7C" the applicable box <br /> (See instrUCtions on back) REQUESTED m FINAL ? PARTIAL ®ACCRUAL <br /> 3. FEDERAL SPONSORING AGENCY AND ORGAN2ATIONAL ELEMENT TO 4. FEDERAL GRANT OR 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 3 <br /> HAF03.1 M01 <br /> <br /> 1 <br /> 6. EMPLOYER IDENTIFICATION 7. RECIPIENTS ACCOUNT NUMBER 8. PERIOD CbVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER FROM (month, day, year) TO (month, day, year) <br /> 93-6002160 1536-0031-8601 October 1, 2004 December 17, 2004 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent it dif/erent than item 9J <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 /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (a) (bJ (c) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ~ <br /> December 17, 2004 TOTAL <br /> a. Total program (as ordate) $ 371,248.55 $ $ $ 371,248.55 <br /> outlays to date <br /> b. Less: Cumulative rogram iricome 0.00 0.00 <br /> c. Net program outlays (Line a minus 371,248.55 0.00 0.00 371,248.55 <br /> line b) <br /> d. Estimated net cash outlays for advance O.OO <br /> eriod <br /> e. Total (sum oPlines c ~ d) 371,248.55 0.00 0.00 371,248.55 <br /> f. Non-Federal share of amount on line a 189,498.55 189,498.55 <br /> . Federal share of amount on line a 181,750.00 1.81,.750.00 <br /> h. Federal a ments reviously r'e uested 180,500.35 180,500.35 <br /> i. Federal share now requested (Line g <br /> minus line h) 1,249.65 0.00 0.00 1,249.65 <br /> 1• 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 s that will be made during 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 /> $ 0.00 <br /> c. Amount re nested (Line a minus line b) <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM z~a (Rev. <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />