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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 C- J::?? 60 L4 (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 Thu ir 54a +e- <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 />The vote or decision involving this interest is on the T&%A Arvi 18; <br />body, and is described as follows: 1-7 - C-:n t^ i r+ S <br />Tel"r s4voi-+z. u.A;v, TDV-X:V"-,-?4 -per, "-I- EXECUTED on t t Ze• (date) <br />Signature <br />me on <br />I?? I?t.a! 1l.Gc i >v? <br />Printed Name F -d( <br />SWORN <br />JANIS K. WOMACK <br />ati?x ue'n Notary Public, State of Texas <br />Not MY Commission Expires <br />A gust 13, 2005 <br />1 II?N N <br />FILED on <br /> <br />date) agenda of the governmental <br />evviwr- <br />(date). <br />No y Public <br />St e of Texas <br />date). ? <br />City Clerk/gf the City of San Marcos <br />COSM Form 4/02