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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,47 Co64, rt C.; (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 _5oL4114 ,,es-4' '1,e xaS <br />te- 1 <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 />X 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 Ao 2,00 (date) agenda of the governmental <br />body, and is described as follows: - %R R I ;? w i <br />>c,&,+A./ej+ I ew^ s 5+mte 0-4; v-cols, <br />EXECUTED on SA hKa?h 13, ZD o 3 (date). <br />Signature W4 <br />P4inted me 4obew+ F3. 14o b;vtgee? <br />SWORN TO AND SUBSCRIBED before a on (date). <br />o?a'r""?",u"ew4 JANIS K. WOMACK ) Notary Notary Public, State <br />Ij of Teas /044wi <br />My commission Expires ' <br />August 13, 2005 Nota ' Public <br />State of Texas <br />%u) (date). <br />FILED on <br />AAAA <br />r--- , <br />City Cleyk of the City of San Marcos <br />COSM Form 4/02