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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 San Marcos Cia'h LO "n u 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 4471,,&- 01 Wail- <br />$1 <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 <br />kinship) or affinity (marriage). Relative's name and relation: <br />The vote or decision involving this interest is on the e 15' 1- 00 1 (date) agenda of the governmental <br />body, and is described as follows: L+-ea 19- AAd A4 c.( se%? u s La-ttf-t?yt`rJ/ S5WTSV <br />EXECUTED on 7t1.?r< o f z Z 0 O .(date). <br />Signature <br />...... v n?"• <br />SWOR JANIS K. ?re eon <br />i No Public, State of Texas <br />:o c t <br />Notary {r rrK `j M commisslonBoms <br />IN±rEOF.?y' AUG. 13, 2001 ? <br />FILED on s <br />Printed <br />try Public <br />e of Texas <br /> <br /> <br />J ??) ,(date). <br />COSM Form 9/99