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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 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 bus* ess entity that is <br />distinguishable from the effect on the public. The name of the business entity is Lf n Z o Cl <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 />I am abstaining only to avoid the appearance of impropriety. <br />The vote or decision involving this interest is on the % //(P/13 (date) agenda of the governmental body, <br />and is described as follows: :-4CVA 10I - C ydl.t 5k. Utvminw Lmm SE —& 4 T <br />EXECUTED on K 1.2,2013 (date). <br />Signature <br />Printed Name Name P,-- k V%-10� (k <br />SWORN TO AND SUBSCRIBED before me on X A a, 3 (date). <br />Notary Stamp: <br />,,1hpYa�; -,,, JAMIE LEE PETTIJOHN o ry is <br />Aj <br />14 •• `'�' "r Notary Public, State of Te as <br />My Commission Expire t e of T xas <br />• Morch 03, 2014 <br />Pill FILED on <7,ZA­0- 3 (date). <br />C' y Clerk o he Vity of �)n Marcos <br />COSM Form 11/10 <br />