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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 a t-?n 60z m , (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 :T&M-r Vx te- <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 0G+ob dr y' 2005- (date) agenda of the governmental <br />body, and is described as follows: AL-vg T' Pnt! mvvt 4 Vat-ra?rd - tGtrG?7? <br />G+*a.-,- + Zd0 't r • o <br />EXECUTED on Ste- (date). - <br />Signature <br />Printed Name " N ` ?1.? F-cc GV? In <br />/ r7 <br />SWORN TO AND SUBSCRIBED before me on j? %??J ?' (date). <br />Nato JANIS ILWWW <br />MY COMMISSION EXPIRES <br />.. August 13,2MV Not r Public <br />State of Texas <br />FILED on J (date). <br />-' h <br />City#erk of the City of San Marcos <br />COSM Form 4/02