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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />I, 1 _ { , a member of the City Council of the City of San Marcos, make this affidavit, and <br />hereby on oath state the following: <br />I have a substantial interest in the below named entity or described property that may be involved in a vote or decision of <br />the governmental body described above, and the vote or decision may have a special economic effect on the named entity <br />or property that is distinguishable from the effect on the public. <br />The name of the business entity is: <br />The real property is: <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 kinship) or <br />affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />I have received more than $300 in campaign contributions from this person, business entity, or association. <br />The vote or decision involving this interest is on the W-]-102,0 (date) agenda of the governmental body, and is <br />described as follows: 0 f m <br />EXECUTED on <br />Printed Name kvii <br />SWORN TO- . me on _'20_ (date). <br />TAMMY K COOK <br />Notary Stamp: My Notary ID # 1259-�TAJAA,-, <br />Expires November 29, 2022 Ntart' ublic <br />\Ij <br />Sta e of Texas <br />FILED on 9 11i/ " (date). <br />City erk of tljr�C' of San Marcos <br />COSM Form 12/2018 <br />