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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 />distinguishable from the effect on the public. The name of the business entity is ToL0.S 1 g(Jo/a�Q <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 />VI-< am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving this interest is on the / 0 1 %s (date) agenda of the governmental body, <br />and is described as follows: Q VV� _( b— ° +,P j' � <br />SWORN' <br />FN <br />FILED on <br />CC <br />