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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 t Vl'l ��T ('�( (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 Mtt that is <br />distin uishable from the effect on the public. The name of the business entity is I �A �— <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 />kinship) 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 -� 1,5 111 <br />and is described as follows: <br />EXECUTED on on I S l I (date). <br />Signature <br />Printed Name �( <br />(date) agenda of the governmental body, <br />1 <br />a <br />SWORN TO AND SUBSCRIBED before me on I� l l (date). <br />' �'► s ; ELIZABETH TREVINO <br />Notary St Notary Public, State of Texas <br />my commission Expires Notary blic <br />October 18, 201 State of Texas <br />FILED on - 7/15 - 11 ( l <br />COSM Form 11/10 <br />(date). <br />ity Cler the City of a Marcos <br />