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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 C', Gat?w•c?c?? , (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 />distinguishable from the effect on the public. The name of the business entity is 'TGKA- r S f? <br />6 mss <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 />The vote or decision involving this interest is on the, (T t?, ZOO (b (date) agenda of the governmental <br />-?-p.?n 13 - S o (? d r..las'l-t .?w? a.,?t.(.i ??h v,.? ??t <br />body, and is described as follows: <br />?j-w?d???.c./ L.+3 ?' f¢v,t of i w?rv ? ?^ ?; r ? `ca.}+?e SesC, ? - M GCJc ?}? L.?.?. ? ?? . <br />EXECUTED on -TL4 t? [ ?. 2 y 0 (o (date). ` n/1A <br />Signature <br />SWORN TO AND SUBSCRIBED before me or <br />JAMS K WOMACK <br />Notar MY COMMISSION EXPIRES <br />August 13, 2009 <br />Nofcar? Public <br />State of Texas <br />FILED on (date). <br />41 1,114, <br />City ,Clerk of the City of San Marcos <br />COSM Form 4/02 <br />Printed Name 6-. PA I" I r-Q vr, ; It