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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT - BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />�0 n/G . <br />The undersigned member of the City of San Marcos CC �, (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 t!y that is <br />distinguishable from the effect on the public. The name of the business entity is .fie aril A . i r/ <br />d Al <br />r' f <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 />Own ip of $15,000 or more of the fair market value of the business entity. <br />Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />The interest described above belongs to a person related to me in the first degree by consanguinity (natural <br />kinship) or affinity (marriage). Relative's name and relation: <br />I am abstaining only to avoid the appearance of impropriety. 1 ;C Ovd z : 7 4M <br />21 20 // <br />The vote or decision involving his interest is on thej uN I (date) genda of t} i governmental body, <br />and is described as follows: s u Gh� 2-0 11- 7$ w ,12 �� ✓1 aCa C �'f `�J�G <br />EXECUTED on V (date <br />Signature <br />Printed Name W <br />SWORN TO AN <br />Nota <br />SUBSCRIBED before me on <br />ELIZABETH TREVINO <br />Notary Public, State of Texas <br />My Commission Expires <br />0WOW 16, 2011 <br />I 1 (date). <br />Y-4 I <br />Notary blic <br />State of Texas <br />FILED on & / ) 1 I )I <br />COSM Form 11/10 <br />(date). <br />City Clerk f the Ci o San Ma co <br />