LM-6 Request for Advance or Reimbursment Form

REQUEST FOR ADVANCE OR REIMBURSEMENT (LM-6) OMB 3076-0006 Exp: 3/2012 (FMCS—Online Version)

 

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Request for Advance or Reimbursement Form

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1.a)	Request Type:	*	Advance	Reimbursement
1.b)			Final	Partial
7)	Period Covered:	*
9.a)	As of Date:	*
9.a)	Total Outlays to Date:	*
9.b)	Cumulative Income:	*
9 .c)	Net Outlays:
9.d)	Est. Net Cash Outlays for This Period:	*
9.e)	Total:
9.f)	Non-Federal Share:	*		Match %:
9.g)	Federal Share:
9.h)	Previous Federal Payments Requested:			Available: 0
9.i)	Federal Share Now Requested:			Total:
Comments / Notes:

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FMCS Form LM-6 (Revised 3/2009)

Standard Form 270

APPENDIX 8