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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 ( Gat 4ZZ , (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 5-6U f'Lt t./Q: + Ta)44 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 />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 Tt,%sne I Go Zo02 (date) agenda of the governmental <br />body, and is described as follows: L{-cv" 2 3 - PoWee (i+ae ?e ?oG ?c? -}? be -f wAoc.d lam <br />.SST S V ? <br />EXECUTED on Iu ti e 1 O1 20 0 2 (date). <br />Signature ?). 11 <br />Printed Name lZebe rr}- ?. ?- b: v? ?v't r ?'(.t a ?? <br />SWO ( SUBSCRIBED before me on (date). <br />% 3.rarv...Y, <br />Notnr R JANIS K. WOMACK <br />Notary Public, State of Texas <br /> <br />09q) <br />N;3 <br />=?;FOf <br />' ,,,??„ My Commission Expires <br />Au August 13 2005 <br />9 <br />N ry Public <br /> S ate of Texas <br />FILED on 40, -(date). <br /> 1 City Clefk of the City ofSan Marcos <br /> <br />COSM Form 4/02