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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT - BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />i o he City o San Marcos �/ `7 Co e, /,/c ` l name of City Board <br />The unders member f t y f ( y , <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 r La e S f o 'f c <br />M Ll hoM <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 />��sf <br />2 .20 <br />The vote or decision involving this i f terest is on the � r (date) agenda of the governmental body, <br />and is described as follows: L�7e� ''� J' #� f 7, # 7 JC, rvc u V, S -P .L) ✓C Z� `�':"�% <br />' J <br />EXECUTED on /o I (date). <br />Signature <br />Printed Namel <br />SWORN TO AND SUBSCRIBED before me on 1�� - I ""L (date). <br />Notary d %� <br />y ; �� ELIZABETH TREVINO <br />Notary Public, State of Texas <br />:*-I My Commission Expires Notnry lic <br />� Ootobef 18, 2011 State of Texas <br />., <br />FILED on -� / g ` I k (date). <br />bi, <br />Clerk of th of San <br />COSM Form 11/10 <br />