Laserfiche WebLink
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 Oil ? (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 />dMingy uishable from the effect on the public. The name of the business entity is 12 ? a- r S-?-? --? <br />S S <br />Thenature 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 f'G& - ?0 2o o6 (date) agenda of the governmental <br />body, and is described as follows: .1??._.±.. Z 1 - hlas t tes-l-;" "r-tet,-elt - EA r-D G <br />EXECUTED on f F-6 yq&Av%A 7, 2,00 (a (date). <br />Signature P,IJ411?r <br />Printed Name " 0; ; VL,41 IZ-4L tit . H <br />SWORN TO AND SUBSCRIBED before me on <br />Nota' r I ` JANIS K. WOMACK I . *-d/ A&?? <br />MY COMMISSION EXPIRES <br />Aupst13,2009 No ary Public <br />State of Texas <br />FILED on (date). <br /> <br />date). <br />Clerk of the City of San Marcos <br />COSM Form 4/02