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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of Son Marcos C 414 C-.("VvC, I (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 Sbu"I'Ltv,/¢s-{- T???S <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 />V 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 J Lt,,,e Ito Zyo 1 (date) agenda of the governmental <br />body, and is described as follows: AKG-I!If c-att 44vvt CeS Gay4a"" c* et farct - 5 WT jF AR.DC . <br />EXECUTED on ZO D ) (date). <br />Signature L?/AJU&V,41 <br />Printed Name h <br />JANIS K. WOMACK <br />°?pr•u?`?' t?otarr Puulic! State of Texas <br />TC7 ?1t?8?9BED fore me on (date). <br />%?+rEOF??+o° Uqust 13, 200 <br />o ary Stamp: <br />FILED on Aa? / <br />Ngp'ary Public <br />State of Texas <br />COSM Form 9/99