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OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348-0004 1 2 PAGES <br /> a. 9C"one a• bath bones 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT 1• ? ADVANCE ® REIMBURSE- <br /> TrPE of MENT ? CASH <br /> l <br /> PAYMENT b. %C"lheapplicable 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 IDEMfIFI'ING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HAF031 M01 2 <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 January 27, 2004 September 30, 2004 <br /> <br /> i <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check 1S t0 be sent Ndifferent 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 /> . Eugene, OR 97401 <br /> and ZlP Cpde. and ZlP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (a) lbJ lcI <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> October 1, 2004 TOTAL <br /> a. Total program (As of date) $ 334 498.90 $ $ $ 334,498.90 <br /> outla to date <br /> b. Less: cumulative rogram income 0.00 0.00 <br /> c. Net program outlays (Line a minus <br /> ~,6ne b) 334,498.90 0.00 0.00 334,498.90 <br /> d. Estimated net cash outlays for advance <br /> riod 0.00 <br /> e. Total (sum ofiines c & d) 334,498.90 .0.00 0.00 334,498.90 <br /> f. Non-Federal share of amount on line a 152,998.55 152,998.55 <br /> . Federal share of amount on line a 180,500.35 180,500.35 <br /> h. Federal a ments reviousl re nested 160,969.35 160,969.35 <br /> i. Federal share now requested (Line g <br /> minus line h) 19,531.00 0.00 0.00 19,531.00 <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 3rd month 0.00 <br /> 12• ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outlays that will be made Burin eriod covered b the advance $ 0.00 <br /> b. Less: Estimated balance of Federal cash on hand as of beginnin of advance eriod <br /> c. Amount re nested (Line a minus line b) $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION {Continued on Reverse) STANDARD FORM 270 (Rev. 7,97) <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />