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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 i Comic ( (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 Sok-r kvje r4- -re,-^s, <br />+ e U ti ?trs <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 />V 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 ft Ar&4,t 3, 2-o? o 3 <br />body, and is described as follows: 14-e w, B'- Re f eoLr4 4 e•Lre wu"%.4 c <br />f r c+..?.r.?..1`? S? T S t) <br />.r+e w? 10- Q ro? w9 y V r4 <br />EXECUTED on 2-00 (date). <br />ja? <br />SWORN <br />or <br />?,o5r,xr v?so, <br />JANIS K. WOMACK <br />= Notary Public, State of Texas <br />Notary S My Commission Expires <br />August 13, 2005 <br />r <br />t• <br />FILED on <br />COSM Form 4/02 <br />Signature ?y <br />agenda of the governmental <br />eca.? Smut -Iro 5 WT51 <br />(date). <br />//1, <br />City Cgrk of the City of San Marcos <br />Printed Name fZ4010W 4-6 • 4" i n arrrcr 01 ee