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CITY OF SAN MARC05 <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos C , (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 <br />S-}a l?K y Per S 1?7 <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 />X 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 IV02"4 1(48"y 5 7'001 (date) agenda of the governmental <br />bod and is described as follows: l'1 - 'V%eoe bawd.o o?.w?,il-tw? <br />I's -14' }<„"LoC"L s W-rT V <br />EXECUTED on 1 (date)?F'j <br />Signature Printed Name <br /> <br />SWORN <br />Notary 5 <br /> ' I <br /> ,PY <br />1 <br /> ?ANotary Public, State of Texas <br /> <br />t LV,:..= My Commission Expires <br /> August 13, 2005 <br /> <br /> <br />State of Texas <br />FILED on (date). <br />5e=-te <br />COSM Form 9/99