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? <br />? <br /> i ?.. , <br />, . ATTACHMENT II <br /> ' Scs?ndnrd Form 270 <br /> 01138 APPRQVAL N0, PAGE OF <br />REQUEST FOR ADVANCE 4.148-WU PnGEs <br />OR REIMBURSEMENT <br /> t. TYPE OF PAYMENT • a. :i"u,re orharl, hosu 8ASi5 QF REQUEST <br /> 1tEQUE57ED ? ADVANCE ? RE:MSUASEMENT ? CASH <br /> h. 'a'rne appJtca6le ba: ? ACCRL1A1 <br /> <br />(Sce +n5tructians on back) <br />C3 FrN'"L 0 PARTIAL' . <br /> <br />FEDEitAI- SPONSORtNG AGENCY AND OitGwNtZATiON ELEME{t7' <br />3 A. fEDERAI GlUM OR fl77iER tDEN7'IFYiNG M.`M14HEA S. PARTlw1. PAYA!MNT <br />, <br />TO WHICHTHIS REPOR715 SUSMtTTED ASStGNEABY FEDEAAL AGENCY REQUESTNU)YGER FOR <br /> ' 7}it5 REQUEST <br />d, EMpLpYEA IDE4Tff1CATiRN 7. x_cIPIErr. s nccovxr <br />- <br />a. PERIOD C0N'ER.ED Bl'rxts REQUEST <br />• ?f,Tg? , .. . . -. . WUTYtAER OR <br /> fDfiNTCrI'ING NUMSER FROM {n?o?uh. d?r, wtarJ . • TO (nro+uh.'do. year) <br />9, ?CIPM'Nrr ORGAMj,A310N 14. AAYEE (Whtte eheek is +a bt srru f d;Q'ercrrf thena Ireni 9) <br />1Jamt . Nome . ' <br />Nvnrder Nun+ber <br />mad Srru . and Strrar . <br />Cir): Store Cfry, Sare . <br />mid Z!P CoAe : <br />m=d tIP Cade : <br /> <br />f•AARPTITATi11A1 nr s aanliwtT fti'C RFt\TATIRSE1?2Et?'T/ADt?ANCE.4 SLEb[lESTED <br />i <br />s <br />i <br />?. <br />a <br />., <br />._: <br />? <br />h <br />F <br />•.. <br />r• <br />r. <br />?Y <br />.' <br />?.? <br />*i <br />i. <br />.? <br />, <br />? <br />i <br />? <br />?.. <br /> <br />PRGGRAM$'fUNCflOI.tS A['FIVITI°,S - <br />(a) <br />(bi <br /> <br />TOTAL <br />4 TOut j!i'O,'1'31I1 (ILT Of flO(t) <br />OUll7yS 10 d7M <br />S <br />s <br />s <br />S <br />b. l.exs: Cu;nntative p-oPam income <br />e. Nei ropam outl»z (l.inr o rtinns line b) <br />d. Estimsted ncieashoutiayx fa adranee <br />pcriod , <br />e. Tatsl (5un, af inx.r r cF d1 <br />[. Nort Fdmi shue'of unouru oI lins e <br /> <br />ai <br />?, . Fedenf s6are of junouat a? Ane e <br />h. Fcdaai payrt+uus pmriousir reqnestc4 <br />i. Fnderi, shue now requested (Line g <br />minus line h) <br />j. Adranaz requ;red by 1 sI manth " <br />month, whep requesrcd by <br />Fedrni gan!or zgency iw <br />?nd month <br />usa io naSant <br />prescheduled adrmees <br />3rd m2ntA <br />12, ALTERNATE COMPUTATlON FOA AD\'ANCES t}NL1' <br />a Etttmwed Fedcni nst, oulti,•s that wll be mad: during period cov:red by the advtnct ' S <br />r. trsx,` fuimsie!! balma o(fcdttal cuh on hand u of beFianing ot advanet period <br />t. 1MOun, reQutSteL (l.iur rr eamrxr lnar hi S <br />A137'HDRIZED FOA LOCN.. AtPAODIiC?JOI+ j(:muiineJ un J;r,Kn'r) Staadarsl form :?G (ke.• : <br />Prese'ibe3 by OfTiee qf Managemrm anC B, <br />[it, No. 0.•IOi anZ t <br />Startdard fiorm :70 (cont'd)