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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 C;:!?, 6 CA- pt i , (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 TP?xa.c 94-&4 e <br />j, 0A, V, PiYSi - V14 <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 f irst 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 NA.sw'+rA Z?-, ?OO'-f (dote) agenda of the governmental <br />body, and is described as follows: T.? ZD- Cw,-tv?c yt' w? ?'1? 17a r. h e K 6-tor" "wi..-; n <br />e w..sj-1-,+c 0 w-v r -r- +Al '!P rA.i w•?,:, V ?-1 j ect- <br />EXECUTED on .G? 2 2? L b 0' f (date). <br />Signature IL4 <br />Printed Name <br />SWORN TO AND SU "CI e on C ?v© (date). <br />,;nYOG JANIS K. WOMACK <br />Notnr Notary Public, State of Texas <br />y ;M.ly My Commission Expires <br />August 13, 2005 ary Public <br />State of Texas <br />FILED on (date). <br />1-\ <br />City ¢Vrk of the City of San Marcos <br />COSM Form 4/02