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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 Couvvc, � Ma. v\ nivi's J A O - , {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 />distinguishable from the effect on the public. The name of the business entity is J t - Q <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 Ulx-A O 11 (date) agenda of the governmental body, <br />and is described as follows: Z- E 1- - fix- �.1��i- � cs 3 . <br />EXECUTED on - 7 / is it (date). �e <br />Signature <br />Printed NamAv iS __ ✓1e S <br />SWORN TO AND SUBSCRIBED before me on `�'�.� (date). <br />Notary Stamp .���::'�•., + n �✓v�� <br />;,.�. � ELIZABETH TREVINO - -- <br />�'. Notary Public, State of Texas tart' UbIIC <br />° My Commission Expires <br />�' %;�'� October 18, 2011 ate of Texas <br />FILED on -� / Is-/ it <br />COSM Form 11/10 <br />(date). <br />City lerk f the Cit ofS an arcos <br />,Y Y (� <br />v <br />