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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 Cr'#Zl 60u .4 c ? , (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 Soui-t4 L v x,i exR s- <br />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 />k 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 V-7 2c <br />body, and is described as follows: S-lkzA-" ?- f=y+-P sbkr <br />EXECUTED on Arf 1 14. zo 03 (date). ? <br />Signature <br />SWOP <br />r''?pr aue?c <br />Notary <br />??i ?f 0itt t <br />Wfore a or <br />Notary Public, state of T exas <br />My Commission ExPi <br />August 13, 005 <br />, <br />FILED on (date). <br />fill <br />date) agenda of the governmental <br />fi ass ?d..,1 me.w1` uM-•? - <br />a-..t I' Ge44A}'e. <br />City/,Clerk of the City of San Marcos <br />COSM Form 4/02 <br />Printed Name Cd IVI I "L IC a vt - vt