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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT <br />STATE OF TEXAS <br />[a 101 v 0 1 WKS) 0 go <br />a member of the City Council of the City of San Marcos, make this affidavit, and <br />hereby on oath state the fol" wing: <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 business entity is: <br />The real property is: <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 this interest is, on the � kA0 1 '8 (date) agenda of the governmental body, and is <br />described as follows: z C- - I e yi, ,*Akjk <br />03) <br />EXECUTED on (date). <br />Signature <br />Printed Name <br />SWORN TO AND SUBSCRIBED before me on (date). <br />AWE [EE PETtlJOHN <br />3ry <br />Notary Stai I Nwary Pubhc, Slate 0n T(�Xas <br />My (,omm�s�;oon F xpifes 'ki <br />Notary ublic <br />March 04, 20 8 <br />.......... <br />State of exas <br />d <br />FILED on')3() (aatq), <br />CA <br />of the -City of San <br />COSM Form 11/10 <br />