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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 "?l (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 !5 t&(x*o eJ+ T;3c.a.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 />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 me 1170 2-00 1 (date) agenda of the governmental <br />body, and is described as follows: I'l - Zl+t?kC?(,yts?.( ?t -wtie 1 &Vj cetme"q'4 . <br />EXECUTED on I?Q c:?? i 7 + Zoo ( (date). <br />Signature ? <br />Printed Name i ,?t 1" 1 I ? «? + ti <br />SWORN TO AND SUBSCRIBED before me on 17?'?P.IM 2-00 1 <br />E 1 1 <br />K. WO - , <br />°°`r?°?? JANIS MACK <br />Notary Notary Public, State of Texas / <br />My Commission Expires 1/1 <br />August 13, 2005 Notary P ' lic <br />State o Texas <br />FILED on <br />City gfcretary <br />date). <br />(date). <br />COSM Form 9/99