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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />'�L' <br />0 I -IJ a member of the City Council of the City of San Marcos, make this affidavit. and <br />----------- <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 business entity is: Ate <br />The real property is: leay <br />sm <br />The nature and extent of my interest in the business entity is as follows: (check all that apply) <br />Y" Ownership of 10 percent or more of the voting stock or shares of the business entity. <br />V 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/ I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision <br />described as follows: <br />EXECUTED on (date). <br />Signature <br />Printed Name, <br />SWORN TO <br />before me on �) r- kJ. <br />Notary Stain SHARON K GLASS <br />11011111 ID # 126378882 tary Public <br />My Commission Expires ate of Texas <br />OF June 31 2020 <br />FILED on <br />LI ,ww <br />A� <br />Gitv0�crf the <br />COSM Form 11/16 <br />(date) agenda of the governmental body, and is <br />�-() 19 . (date), <br />of San Marcos <br />