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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 (r 4-1, 6 (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 s Sc ¢C ,- <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 />V 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 S`1 1-vO (date) agenda of the governmental <br />body, and is described as follows: - M It, <br />EXECUTED on (date). <br />5ignature.? -V V <br />Printed Name r?-tJ? t k-a ( k-IIL Vt y <br />re me ondate). <br />414 <br />JANIS K. WOMACK .._ I ?- <br />Notary Public, State of Texas <br />: My Commission Expires ?Ck <br />August 13, 2005 11 Not°f Public <br />State of Texas <br />FILED on 9001-- ..,date). <br /> <br />City Clerk of the City of San Marcos <br />COSM Form 4/02