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CITY OF SAN MARC05 <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos 0 C ie j , (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 'Fles--,5 <br />1f YA i?ers i '}'-- 5" 0/t4r.YT OS <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 µ.H 11 ?oC (date) agenda of the governmen <br />ts- S?e. sor??t <br />body, and is described as follows: z*7- - a _44e_& <br />t-- e:rv V`1.+ ern j? vF <br />EXECUTED on 77A " K&!aj 12-1 ZOO (date). <br />Signature <br />Print <br />SWORN TO AND SUBSCRIBED- before me on <br />JANIS K. WOMACK <br />Notary Public, State of Texas <br />My Commission Expires <br />Auaust 13, 2005 <br />FILED on <br />Name e? d- 14,4 1 k4 ( ?a t4 : 6, <br />date). <br /> <br />Nota ublic <br />Sta of Texas <br />(date). <br />City CI Ali of the City of San Marcos <br />COSM Form 4/02