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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 Son Marcos (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 Ci?o-t. 114 tale r4 7 exaf <br />.? f-e L) .4 ers i ±13 <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 AvAks4' 2-6UO7- (date) agenda of the governmental <br />body, and is described as follows: 4-r c.., 22 - 4- e 016,K1 c--.t <br />se ?v? ct.,r uat?-e ?w?s wf- a,J; <br />ScWTS v- EXECUTED on 6Ks Zo o 'L_. (date). IiL <br />Signature <br />Printed Name 1? & M i ko, ( Kit t i' <br />SWORN TO AND SUBSCRIBED before me on o`?4 date). <br />??RY PV ?t ,.f,4NIS K. WOMACK <br />Nota ' Movirl, Public, State of Texas <br />My commission Expires Not Public <br />August 13, 2005 <br />Sta tof Texas <br />FILED on <br />date). <br />City Olerk of the City'of San Marcos <br />COSM Form 4/02