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I <br /> OMB APPROVAL NO. PAGE OF <br /> 0348-0004 1 2 PAGES <br /> _ REQUEST FOR ADVANCE a.'~C•oneorvorhboxes 2.8ASISOFREQUEST <br /> OR REIMBURSEMENT <br /> ? ADVANCE ® REIMBURSE- <br /> j TYPE OF MENT ? CASH <br /> PAYMENT b. "7C'Ehe applicahle box <br /> i (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 /> it WHICH THIS REPORT IS SUBMITTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> U.S. Bureau of Land Management HAF041 M05 1 <br /> 6. EMPLOYER IDEMIFICATION 7. RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER FROM (month, day, year) TO (month, day, year) <br /> j 93-6002160 1536-0031-8601 September 23, 2004 June 30, 2005 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (lNhere check Is to be sent lfdiflerent than Item 9) <br /> i <br /> i <br /> ~ Name: City of Eugene Name: <br /> I <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 /> i <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> PROGRAMSlFUNCTIONS/ACTIVITIES <br /> Native Plant Materials TOTAL <br /> a. Total program (As of date) $ 26 453.83 $ $ $ 26 453.83 <br /> outla to date ~ ~ <br /> b. Less: Cumulative program income 0.00 0.00 <br /> ' c. Net program outlays (Line a minus 26,453.83 0.00 0.00 26,453.83 <br /> <br /> i line b) <br /> d. Estimated net cash outlays for advance 0.00 <br /> riod <br /> e. Total (sum otlines c s d) 26,453.83 0.00 0.00 26,453.83 <br /> f. Non-Federal share of amount on line a 0.00 0.00 <br /> . Federal share of amount on line a 26,453.83 26,453.83 <br /> h. Federal a ments reviousl requested 0.00 0.00 <br /> i. Federal share now requested (Line g 26,453.83 0.00 0.00 26,453.83 <br /> minus line h) - <br /> 1• 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 outla s 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 /> \UTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) sTANDARD FORM zoo (Rev. ~-s~ <br /> Prescribed by OMB Circulars A-102 and A-110 <br /> _ _ <br /> <br />