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- OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 034$-0004 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. '7("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 /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HEF041 M07 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 October 27, 2004 June 30, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent if different 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 /> and zlP code: Eugene, OR 97401 <br /> and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ~ <br /> Fuels reduction TOTAL <br /> a. Total program (AS Of date) $ 13 000.00 $ $ $ 13 000.00 <br /> outla s to date ~ , <br /> b. Less: Cumulative rogram income 0.00 0.00 <br /> c. Net program outlays (Line a minus 13,000.00 0.00 0.00 13,000.00 <br /> line b) <br /> d. Estimated net cash outlays for advance <br /> eriod 0.00 <br /> e. Total (sum oflines c & d) 13,000.00 0.00 0.00 13,000.00 <br /> f. Nan-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 13,000.00 13,000.00 <br /> h. Federal a menu reviousl requested 0.00 0.00 <br /> i. Federal share now requested (Line g 13,000.00 0.00 0.00 13,000.00 <br /> minus line h) <br /> <br /> L 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 /> <br /> a. Estimated Federal cash outla s that will be made during eriod covered b the advance $ 0.00 <br /> <br /> b. Less: Estimated balance of Federal cash on hand as of be innin of advance eriod <br /> Amcunt re uested (Line a minus line b) $ 0.00 <br /> JTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTaNOnRO FORM 2~0 (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> <br />