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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />G�y �✓ryice <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 usiness a tity that is <br />distinguishable from the effect on the public. The name of the business entity is �1� ,44 Ile AIPr <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 $15,000 or more of the fair market value of the business entity. <br />Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />The interest described above belongs to a person related to me in the first degree by consanguinity (natural <br />kinship) or affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving this interest is on the NIA (date) agenda of the governmental body, <br />and is described as follows: <br />EXECUTED on (date � <br />Signature <br />Printed Name <br />SWORN TO AND SUBSCRIBED before me on (date). <br />Notary St P q > °P °� �A�iBE SEE P�Y�9,k�iHEV <br />Z'S." r e By t ry ��Vii State 0 �4 x�� <br />a y r,�rwrrom s,<�r �mxK"f' Notary 'UbIIC <br />a �s�d, ®$ Mann 0 2�1 State o Texas <br />FILED on <br />COSM Form 11/10 <br />