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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 Son Marcos e•*hl Cst vv-c i , (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 f rom the effect on the public. The name of the business entity is 1-e of 5- +4- <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 />...._._.. _..-........ <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 a`? i aOOV(date) agenda of the.governmental <br />body, and is describe as follows: k = (-L 12T S ?10o.wc o G' C ?r c ?MGw'C w -TSV :Lw . <br />EXECUTED on L/ (date). <br />wl/ <br />Signature M <br />Printed Name G d AIL lti.o-l` K- 't H ' %A <br />SWORN TO AND SUBSCRIBED before me on (date). <br />Notary Stamp: <br />Note Public <br />State of Texas <br />FILED on ? 'ZOO (date). <br />Cityklerk of the City of San Marcos <br />COSM Form 4/02