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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 Gy u v% c. j (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 5 v "4h L jz r4- Te,>ck s <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 I-r- , + 011 x-ov 3 (date) agenda of the governmental <br />body, and is described as follows: _I??w, $- pia o tJsc Aorc.Q.w ,K-f 61J;4'? Sri 0 <br />EXECUTED on I?-?y?t1 a W1-A U ?2?y 3 (date). <br />Signature <br />Printed Name Ed 44 ' (/ut l I`-A k-1 L4 <br />SWORN TO AND 5UBSCRIB fore me on (date). <br />t,arvri,?ry JANIS K. yyOMACK <br />tery public, State of Texas <br />My Commission Expires <br />August 13, 2005 NO ry Public <br />State of Texas <br />FILED on ?t ?1 6' (d9te). <br />. 17 City CI/Erk of the City of Son"Marcos <br /> <br />COSM Form 4/02