01.15.13 Regular Meeting - Laserfiche WebLink

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CITY OF SAN MARCOS DISCLOSURE AFFIDAVIT- BUSINESS ENTITY STATE OF TEXAS COUNTY OF HAYS coc( T he undersi 9 Y ned member of the Cit of San Marcos W C t, (name of City Board, Commission, etc.) states under oath as follows: I have a substantial interest in a business entity that may be involved in a vote or decision of the governmental body described above, and the vote or decision may have a special economic effect on the business entity that is distinguishable fro the eff ct on the public. The name of the business entity is° The nature and extent of my interest in the business entity is as follows: (check all that apply) Ownership of 10 percent or more of the voting stock or shares of the business entity. Ownership of 10 percent or more of the fair market value of the business entity. Ownership of $15,000 or more of the fair market value of the business entity. Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. The interest described above belongs to a person related to me in the first degree by consanguinity (natural kinship) or affinity (marriage). Relative's name and relation: I am abstaining only to avoid the appearance ''ojf` impropriety. The vote or decision involving this i terest is on the �/ 4_ &C&r �t 20 date) agenda of the governmental body, and is described as follows: � M l kr are o 2 ZIC EXECUTED on �� n 2'V (date). e Xc r Sfa a^`' Ole r't A7 Signature i�,cZ Printed Name PC)I, C SWORN l Nota ::v FILED on cc