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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 60"Yk Cd , (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 SoL4 -tk Ljes'4- 1--)As <br />S a te- M -'yQ r5-i :b4 <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'- (1Nw <br />body, and is described as follows: Q-e wi s 13, I io a wd <br />5cx,.tUa!est 1 e>cwr <br />EXECUTED on SAHKajet% 130 2-4 o3 (date). <br />Signature <br />I_I - &r6=vr% r% u <br />) agenda of the governmental <br />Printed (`lame IF--,CC 1" t s'Lt ( KCa P% i ?? <br />SWORN TO AND SUBSCRIBED <br />'ore me on W V, <br />Notary Public <br />Slate of Texas <br />(date.). ? <br />date). <br />;'pr.... <br />?$40MP: Notary, <br />My Con., xr <br />FILED <br />COSM Form 4/02 <br />City S11erk of the City of San Marcos