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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 C -t' 6k K o , (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 "Tee A. c S-4-&-4 e <br />?V y t K ow. t o 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 />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 Vt?LA-- 2.7-1 20o`f (date) agenda of the governmental <br />body, and is described as fallows: ? 'La- ?+n?-?.? yt" ?+???^ ?c?n K b??r?'?-?..?? yrA-o-+?! <br />G . k u+ot% s vv. Tl C w..,r J+ ,+x 0 ,%;#vvvsi+ 17 ??t.?,,.,.? ? 'esfi <br />EXECUTED on (date). <br />Signature <br />Printed Name E-ea 1014; k14.1 96t vt I vl? <br />SWORN TO AND SUBSCRIBED before me or <br />_S*omp:'Pu0 IC, ,itdte Texas <br />My Comm ss .?n xr_• res <br />State of Texas <br />FILED on ` (date). <br />n. <br />City QJirk of the Cify of San Marcos <br />COSM Form 4/02