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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 <br />Cl <br />l 0 yWCt <br />( , (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 effec�n the business entity that is <br />distinguishable from the effect on the public. The name of the business entity is ��C� S- %t•-<� <br />hl�ir5 — v� Wtarrv5 <br />The nature and extent of my interest in the business entity is as fol lows: (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 />ki hip) or affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving this interest is on the .?I ! 1 (da e) agenda of the governmental body, <br />and is des4riibedas follows: ����°"'� ym wAw^ +-' <br />Wi4lww4'T 11^e 5' f - t7so --O. VW4 a.�[ !.►..w��- .b <br />EXECUTED on 1�'lfi�_ 1 (date). <br />Signature <br />Printed Name r , <br />SWORN TO AND SUBSCRIBED before me a <br />Notary Sto p,�: kUEY GOODMN <br />9' ? My CrIMMISSION EXPIRES <br />UsbtW 2% 2019 <br />FILED on <br />COSM Form 11/10 <br />State of Texas <br />of the City offSgh Marcos <br />ti. <br />