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CITY OF SAN MARCO5 <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos C4 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 <br />o?.. tLt?er? j P,«r <br />S{a-tQ Jki;verfi+f <br />The nature and extent of my interest in the business entity is as follows: (check all that apply) J <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 />_'K <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 OC-4-0 ber 11, 1 99 (date) agenda of the governmental <br />body, and is described as follows: C-?Ce S-e. -Irp? Us.- 11jr- Pra-c?,'c:e (-fields <br />EXECUTED on O C- +-b b-C? 1 9q °1 (date). <br />Signature <br />Printed Name F5 (? G ?4 o d r L <br />5WO :• ' "' •. D 5?2 fo me on <br />,rt c, Notary Public, State of Texas <br />Nota?r4 My CommissionExplres <br />TF of !AUG. 13, 2001 <br />Notar ublic <br />FILED on <br />6t'?' 11 )?f // <br />COSM Form 9/99 <br />State"of Texas <br />date). <br />City 5elyretory <br />Jh( l <br />? ? / (date).