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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 G }Z, C-Dk jA C, 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 _So vf- '1U¢ j -F <br />Sfi? f- e- vN 1, Jr rr I +t1 <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 Ja i wi Z?j zooo (date) agenda of the <br />body, and is described as follows: _Dr tc sc; uv. o,.+ ac4w; s; w?? a-F 54Y? ---.,.c-a <br />EXECUTED on J u K K A!2?3 2 Z 10 d (date). <br />Signature <br />i <br />Printed Name FU C44- <br />SWORN ? UBWMEWOVII)MAW on ???J J ?'?C/ <br />( * 1, Notary Public, State of Texas <br />Notary S d?q?Y' ??.. f My Commission Expires <br />•!rfoF,?± AU G. 13, 2001 l? y <br />Notn Public <br />State of Texas <br />C A <br />FILED on r (date). <br />City cretary <br />date). <br /> <br />COSM Form 9/99