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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 Son Marcos eih3 (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 I cxjL s Sfft Vc UK;*/trs: <br />S1 ?,,Lg, cos <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 decisioh involving this interest is on the Dec?,t,?nbti??, X *03 (date) agenda of the governmental <br />body, and is described as follows: Z4-e44A IZ-,A --69.R"F 5't, /ard /4.,w w•,, 0;+,tj -Fcx r <br />EXECUTED on ?G? be r 1. Z 00 (date). <br />Signature "A (L I d <br />Printe Name f2-c,(o w+ Na6?Kc ??'??-?'1'(??` <br /> <br />SWORN T-^ a?iR si?BSCrzrQPh I-Pin .+. pn ??? ?`'' 4? (date). <br /> JANIS K. WOMACK <br />Notar <br />Public <br />Stat <br />of T <br />x <br /> <br />Notary 5 , <br />y <br />e <br />e <br />as <br />My Commission Expires <br /> ""••EO„;:°? August 13, 2005 Notary public <br />State bf Texas <br />FILED on !I/)'1? IL/ (date). <br />City Clem of the City of San Marcos <br />COSM Form 4/02