New Search
OMB APPROVAL NO. PAGE OF <br /> 0348-0004 1 2 PAGES <br /> REQUEST FOR ADVANCE a.'~C"oneabothboxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT 1~ OADVANCE ? REIMBURSE- <br /> . TYPE of MENT 0 CASH <br /> PAYMENT b. '7C"the applicable box <br /> (See instructions on back) REQUESTED 0 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 SUBMRTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HEF051 M09 1 <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 1, 2007 December 31, 2007 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where Check is to be Sent if ditrerent than item 9) <br /> Name: Clty 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 ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (aI (b) (c) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? <br /> Engineering Construction TOTAL <br /> a. Total program (As of date) ~ 2,000.00 Q 0'000.00 ~ Q ~ O'ooo•oo <br /> outla s to date G W O ~P <br /> b. Less: Cumulative ro ram income 0.00 0.00 0.00 0.00 <br /> c. Net program outlays {Line a minus 2,000.00 8,000.00 0.00 10,000.00 <br /> line b) <br /> d. Estimated net cash outlays for advance O.OO <br /> eriod <br /> e. Total (Sum oflines c & d) 2,000.00 8,000.00 0.00 10,000.00 <br /> f. Non-Federal share of amount on line a 0.00 0.00 0.00 0.00 <br /> . Federal share of amount on line a 2,000.00 8,000.00 10,000.00 <br /> h. Federal pa ments reviousl r uested 0.00 0.00 0.00 <br /> i. Federal share now requested (Line g 2,000.00 8,000.00 0.00 10,000.00 <br /> minus line h) <br /> J• Advances required by <br /> month, when requested 1st month O.OO <br /> by Federal grantor <br /> agency for use in making 2nd month O.OQ <br /> prescheduled advances O.OO <br /> 3rd month <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outla that will be made durin period covered b the advance ~ O.OO <br /> b. Less: Estimated balance of Federal cash on hand as of beginnin of advance riod <br /> c. Amount requested (Line a minus line b) $ O.OO <br /> <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev. 7-97) <br /> Prescribed by OMB Circulars A-102 and A-11.0. <br /> <br />