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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />a <br />The undersigned member of the City of San Marcos ? 6r'' -r,( , (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 />di uishable from the effect on the public. The name of the business entity is <br />J' ttiV4_1 �a �r <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 />kins ') or affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. <br />261 f The vote or decision involving this interest is on the (date) agenda of the governmental body, <br />and is described as follows: <br />EXECUTED on iiZ` <br />(date). L <br />Signature <br />Printed Name <br />SWORN TO AND SUBSCRIBED before me c <br />Notary S 9HELLEY CO"N <br />ts.y COMMISSIM EXPIRES <br />O*W28,2013 <br />Olai _ v1 ICAas <br />FILED on ao I k (date). <br />COSM Form 11/10 <br />