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? <br />C <br />? - <br />? <br />ATTACHMENT II <br />Standard Form 270 <br /> OM8 MPROVAL NO. PAGE OF . ' <br /> 0149•0004 PAGES <br />REQLtEST FOR ADVANCE <br />OR REIMBURSEMENT <br /> t. 7YPE OF PAYMENT a. ;1'" uuc or hmh boses BAS1S OF REQUEST <br /> REQUESI'ED 13 pDVANCE ? REIMBURSEMENT ? CASH <br /> b, ",1'rhe uppJicuhlr Aos ? qCCRUAL <br /> ? PARTIAl <br />11 FrNA <br />(See instructions on back) . <br />- <br /> <br />FEDERAl. SPONSOR[NG nGENCI' AND ORGANLZATION ELEMENT <br />; 4. FEDERAL GRANT OR OTHER IDENTIFYING M]MBER 5: PARTIAL PAYMENT <br />. <br />TO WHiCH TH1S REPORT 15 SUBMtTTED ASSiGNED B1' FEDERAL AGENCI' R.EQUEST Nl1MBER FOR <br /> ' THiS REQUEST <br />5. EMPl.OYER IDENTIFICATION 7. RECIPIENTS nCCOUNT a. PERIOD CONIERED Bl' THIS REQUEST • <br />NUtvffiER . . . . .. ' NUMBER OR <br /> IDENTIFY[NG NUMBER FROM (nion/h, dm, w:or) TO (ninqth.'dup, year) <br />9. RECIPIEhrf ORGANIZATION 10, PAYEE (Wherc chrck it to bc scn/ if diffeirnr thun ireni 9) <br />Nanx . Nume . <br />Num6cr Nwuber <br />n»dS/xcf . andSrrrel . <br />Cit),, Slarc Ciry, Smlr . <br />otid ZIP Codr : . mid ZIP Codc <br />COMPUTATtON OF AMOUNT OF REIMBURSEMERT/ADVANCES REQUESTED <br /> <br />PROGRAMS/FUNCf10NS ACTfVITIES ? Ia) (b) (?) <br />TOTAL <br />a. Total prognm (Av nJdareJ <br />outlays to day ' <br />S <br />S <br />S <br />S <br />b. L.c.cs: Cumulaiivc program income <br />c. Nct proFram auUays (l.inr o niinns liur b) <br />d. Estimaicd not cazh outiays (or advancc <br />period . <br />e. Total (Sum af bnes c d- d) <br />f. Non-Fcderal share of arnouni of line e <br />F, .Fedcral sharc of arnount on line e <br />h. Federal paymcnu prcviousiy requested <br />i. Federal share now requesicd (Linc g <br />minus line h) <br />j. Advances required by Isi month <br /> monih, whcn re4ucsied by <br />Fedcral granior agcncy for <br />?nd month <br /> use in making <br />prescheduled advances <br />3rd month <br />12 <br />AI.TERNATE C0NIPUTAT)OM1 FOR ADVANCES QNLI' <br />a. Estimated Fetierzl cash outlays thai N•ill be madc durinF period covcred by the advance <br />b. Lr.rr: Esiimated balanee of Fedcral cash on hand as of beFinninc of advance period <br />c. Amount reauesied (Linr n iumu.rlmr A/ <br />AU7liOR12ED FOR LOCAL REPRODUCTIOK <br />. S I <br />fCnrui?wrd uu JfrrrrscJ <br />Standard Form 2_70 (cont'd) <br />I <br />S <br />Sundard Form 27(1 {K:,. ?. <br />i'rucribcd b), OfGcc of Nlanagemem and Butcc <br />Cir. No. A•)02 and A-! f <br />i