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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 CA47 CC(,? CA (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 <v"4-kLve ct 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 />Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />-1Z 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 Vece-r e"V-17 Z001(date agenda of the governmental <br />body, and is described as follows: L+e kyt 21 -Tn <br />EXECUTED on Dec-C,&y,6 e-,r- 179 2-00 L (date). <br /> <br /> Signature <br /> Printe Name q- -ex 0 c <br />PNO AND SUBSCRIB <br />SWO <br />C <br />U <br />A me on ?'+ wJ '/ `- "A (date). <br /> <br />WOMACK <br />S <br />J <br />Noto 's_ Notary Public. State of Texas <br />ir es <br />Ex 41, 914 <br />O <br />p <br />My Commission <br />August 13, 2005 N ary Public <br /> S ate of Texas <br /> <br />/Y? <br />FILE <br /> <br />(date). <br /> <br /> City cretary <br />COSM Form 9/99