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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 04 ?% 6 k44c-; , (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 _50&1 tLJ er? T?eX 11.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 J?"% 9. Zo 0 3 (date) agenda of the governmental <br />body, and is described as follows: T 1 - r• Z-. - Of 62t4cd14 S&Sati, <br />a <br />EXECUTED on ?? K 2 c Z 0 o 3 (date). <br />Signature <br />Printed Name f2obto'v'T ? L??Kq?? ??' <br />5WOR <br />?48N` <br />Notary ?. <br />l' <br />FILED on <br />JANIS K. 0 ACK" on t <br />Notary Public, State of Texas , <br />My Commission Expires ?J? <br />August 13, 2005 w <br />N (ary Public <br />State of Texas <br />(date). <br />date). <br />City tff'erk of the City of San Marcos <br />COSM Form 4/02