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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT - BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS 6/��Jr�� The unders igned member of the City of San Marcos CSvVIA/� (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 the business =ity at is <br />disti from the effect on the public. The name of the business entity is Sz . <br />The nature and extent of my inte est 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 - 7 /,S I I I (date) agenda of the governmental body, <br />and is d scribed as follows: k�_ Va ; I ; . ink ,LA 4 mn Q f AL. ' - L"A&k k- 1- <br />EXECUTED on - 7 //t (date). _ <br />Signature <br />Printed Name h-2 <br />SWORN TO AND SUBSCRIBED before me on <br />Notary 5" <br />FILED on <br />ELIZABETH TREVINO <br />Notary Public, State of Texas <br />My Commission Expires <br />October 18, 2011 <br />, M...w <br />i's <br />COSM Form 11/10 <br />(date). <br />Notary Wub Iic <br />State of Texas <br />(date). <br />qty Cler the City of a Marcos <br />