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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />TATE OF TEXAS <br />UNTY OF HAYS <br />The undersigned member of the City of San Marcos 0-;±7, Gnt?.?G+ , (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 <br />5" oA a,,.,r o 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 />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 dov• 10, 2oo3 (date) agenda of the governmental <br />body, and is described as follows: L4W <br />%??i1+?GC w?iv?%E' ""'0'" d o°re "rr?;,? ? fi <br />EXECUTED on Mov'4w"69-' I 2 00 3 (date). <br />Signature ;1v ` <br />Printed Name i5? M# k A i r-A N' h <br />Lv <br />SWORN TO AN e me on <br />aYP?, JANIS K. WOMACK <br />?1: Notary Public, State of Texas <br />Not a7i4rit?: My Commission Expires [//7) <br />vAugust 13, 2005 0 ar P blic <br />State Texas <br />FILED on <br />date). <br />? (date). <br />City Cle/k of the ty Zf Son Marcos <br />COSM Form 4/02