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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />I,► a member of the City Council of the City of San Marcos, make this affidavit, and <br />hereby on oath state the following: <br />I have a substantial interest in the below named 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 named entity that is distinguishable <br />from the effect on the public. <br />The name of the usiness entity.is: <br />I%�twlf <br />reaI <br />I <br />property is: <br />�� <br />w <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 kinship) or <br />affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving <br />�g thisinterest is on the 1 ! 1 1 (date) agenda of the governmental body, and is <br />described as follows;) -7 rr x ivy ��e.. <br />EXECUTED on ,� ,-� (date). <br />Signature <br />Printed Name <br />SWORN TO AND SUBSCRIBED before me on < kI I� ► 4-, <br />Notary Sta ° �" @ JAMIE LEE PE TU HN M <br />4Nwary puhhc, Se of l xr s <br />My Cornrnssion E xpii es Otary bI1C" <br />Mooch X74, 201 8 State of Te as <br />°°+nr®auex e° <br />FILED on r ,. I 1 N 7 "-Oat <br />Clerk```of the City of San Marcos <br />COSM Form 11/10 <br />