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ATTACHMENT F <br />Standard Form 270 <br />•• OMB APPROVAL NO. PAGE OF <br /> 0348-0004 PAGES <br />REQIJEST FOR ADVANCE <br />OR REIMBURSEMENT 1. TYPE OF PAYMENf a. 'X"one or both boxes BASIS OF REQUEST <br /> REQUESTED ? ppVANCE ? RENtBURSEMENT ? CASH <br /> b. 'X"the applicable boz ? ACCRUAL <br /> ? FINAL ? PARTIAL <br />See instrucrions on back <br />3. FEDERAL SPONSORING AGENCY AND ORGAAIIZATION ELEMENT 4. FEDERAL GRAAiT OR OTI-IER IDENTIFYING M3MB£R 5. PARTIAL PAYMENT <br />TO WHICH THIS REPORT IS SUBMITTED ASSIGNED BY FEDERAL AGENCY REQUEST NUMBER FOR <br /> TFIIS RE UEST <br />6. EMPLOYER IDENTIFICATION 7. RECIPIENT'S ACCOUNT 8.PERIOD COVERED BY THIS RE UEST <br />NUMBER NUMBER OR <br /> IDENTIFYING FROM (month, day, yeor) TO (month, day, year) <br /> NUMBER <br />9. RECIPIENT ORGAMZATION 10. PAYEE (Where check is to be sent iJdwerent than item 9) <br />Name . Name . <br />Number Number <br />nnd Street . and Street . <br />Ciry, State City. 5tate <br />and Z/P Cnde ? and Z/P Code : <br />t t(`(1MPi1TATi(1N !1F AM(l1INT (1F RF.iMRiiRSF.MF.NT/ADVANCF.R RF.ntiF.RTF.Y] <br /> <br />PROGRAMS/FUNCT[ONS ACTIVITIES < (a) (b) (c) <br />TOTAL <br />a. Total program (As ojdare) <br />outla s to da <br />$ <br />$ <br />$ <br />$ <br />b. Less: Cumu{ative rom income <br />c. Net rom ouUa s(Line n minus line b <br />d Estimated net cash outlays for advance <br />eriod <br />e. Total Sum o lines c& d <br />f. Non-Federal share of amount of line e <br />. Federal share of amount on line e <br />h. Federat a nts reviousl reuested <br />i. Federal share now requested (Line g <br />minus line h) <br />j. Advances required by I st month <br />month, when requested by <br />Federalgrantor agency for <br />2nd month <br />use in making prescheduled <br />advances <br />3rd month <br />12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br />a. Estimated Federal cash outlavs that will be made durine oeriod covered bv the advance <br />? <br />c. Amount requested (Line a minus line b) ?$ <br />AUTHORIZED FOR LOCAL REPRODUCTION(Continued on Reverse) Standard Form 270 (Rev 2-92) <br />Prescn'bed by Office of Management and Budget <br />Cir. No. A-102 and A-110 <br />Standard Form 270 (cont'd) <br />13. CERTIFICATIQN