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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-(2.-L7, C? rti,A C r _(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 _!57. 'Lt L,/e S4- -Fe "a, <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 $15,000 or more of the fair market value of the business entity. <br />X_ Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />The interest described above belongs to a person related to me in the f irst degree by consanguinity (natural <br />kinship) or affinity (marriage). Relative's name and relation: <br />The vote or decision involving this interest is on the7Ank 2$? ZODZ. (date) agenda of the governmental <br />body, and is described as follows: A-ar4A-w%c-*-tw;41A <br />S V arG?tat oGo ' c Sure <br />EXECUTED on Tom. VA VLa N!!4 Z g, Z D O Z (date). ,Signature i'd <br /> <br />SWORN C?/ <br /> on <br />a? <br />JANIS K. WOMACK <br />Notary Public, State of Texas <br />Notary ??. My Commission Expires <br />"'' <br />' <br />`` <br />; <br />. <br />FO?? <br />•A <br />August 13, 2005 <br />No jry Public <br /> S ate of Texas <br />FILED on Gam- Oc? °< (date). <br /> <br />COSM Form 9/99 <br />Printed Name F G? M r k_A-1 k_1r,(vt ; V1