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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 ??? (?o L4AA `< (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 S'o ?,-m%,je r? T2x -r <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 ??..y. e 7, Zo d 3 (date) agenda of the governmental <br />body, and is described as follows: T4s.w. I - / srws.?-c...fi o ^ r24trh, ?sc?-Gw..,.?a /?o,+-?•?•+??7 <br />EXECUTED on "S"" e c?. 2 003 (date). / <br />Signature /// <br />SWORN <br />Notary <br />? IK`1l. V 1 KI"11.AO <br />111111111 <br />JANI3 K. WOMACK <br />. = Notary Public, State of Texas <br />,a My Commission Expires <br />August 13, 2005 <br /> <br />or <br />FILED on (date). <br />COSM Form 4/02 <br />Cityplerk of the Cityof San Marcos <br />Printed Name (-I Ck M i I_ta I "PA; y\