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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT - BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos (name of City Board, <br />Commission, etc.) states under oath as follows: <br />I have a substantial interest in a business entity that may be involved in a vote or decision of the governmental body <br />described above, and the vote or decision may have a special economic effect on the business entity that is <br />disti ui�eble fron the effect on the public. The name of the business entity is i 9a�PS C <br />P�ro F - /yHs't', sP <br />The nature and extent of my interest in the business entity is as follows: (check all that apply) <br />Ownership of 10 percent or more of the voting stock or shares of the business entity. <br />Ownership of 10 percent or more of the fair market value of the business entity. <br />Ownership of $15,000 or more of the fair market value of the business entity. <br />Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />The interest described above belongs to a person related to me in the first degree by consanguinity (natural <br />kinship) or affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving this interest is on the I D 1 A I 13 (date) agenda of the governmental body, <br />and is described as follows: �Cww\ *a2(o— t^,UR429e&LQ 4- W-)\A, 1,LL <br />EXECUTED on /C)12 1 (3 (date). <br />Signature G►, <br />Printed Name <br />SWORN TO AND SUBSCRIBED before me on f�� 3 �3 (date). <br />Notary Stamp arPo-, JAMIE LEE PETTIJOHN <br />' tar Pub <br />Notary Public, State of T a y <br />'s.Gy r My Commission Expire 5 to a I <br />` March 03, 2014 <br />FILED on ©cif 2 go i <br />COSM Form 11/10 <br />