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CITY OF SAN MARC05 <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos G'4:2, 6-1n .C.-'f (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 TP a-s' - -1-C LA"; ? - <br />Vt Lw??n 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 -o v 4<-w? lour 27 Zoofdate) agenda of the governmental <br />body, and is described as follows: EXe c-A .%A` sess? w. ??-e w?- I oeoC S+v eA - 4 kI- - t,%) <br />? . <br />Cf o-r 6 : 00 Qw, 5644%^L Nitt&h% a-J- 7: OD U. ` <br />EXECUTED on J o. L,? 7--7 7,-ov (date). <br />Signature <br />d4l V, <br />Printed Name 1?? M r k---, ( <br />S ore me on <br />ao??'P?;` J I c. <br />Notary Public, State of Texas <br />N 3 : My Commission Expires I <br />0i iW ,mp' August 13, 2005 <br />Notar Public <br />State of Texas <br />FILED on A (date). <br />A <br />date). <br />City 4/erk of the City of San Marcos <br />COSM Form 4/02