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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 0.1,47. 4 (fa Ot ?l 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 nameof the business entity is _<ou-rhWes+ ) k-rra 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 />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 u ! 22 2 ooZ (date) agenda of the governmental <br />body, and is described as follows: Si-e-w? ! $ -?.wt ?„r ; ; .? 1 ' .?.C Serti/; ccs. <br />EXECUTED on 'Tu. (M 2,7-, 2-0o2- (date). <br />Signature <br />Printed Name koloe4- (-' vi I'e, I'tile <br />SWORN T C <br />BS$ D <br />Te <br />°= Notary Pubic, tale o ex s <br />'- ' My Commission Expires <br />Notary StaNO August 13, 2005 <br />INOTarly YUDIIC <br />State of Texas <br />FILED on (date). <br />?-Do -r,.- <br />date). <br />City/,Clerk of the City of San Marcos <br />COSM Form 4/02