Hexagon Transportation - Annual 2012Please type or print in ink.
1. Office, Agency, or Court
Agency Name
05� (:it-I
STATEMENT OF ECONOMIC INTERESTS
► If filing for multiple positions, list below or on an attachment.
Agency:
2. Jurisdiction of Office (check at least one box)
❑ State
❑ Multi- County
City of
COVER PAGE
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Position:
/Date Received
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❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (check at least one box)
Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left
December 31, 2012. (Check one)
-or-
The period covered is
December 31, 2012.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
through O The period covered is January 1, 2012, through the dale of
leaving office.
O The period covered is through
the date of leaving office,
and office sought, if different than Part 1:
4. Schedule Summary 3
Check applicable schedules or "None." ► Total number of pages including this cover page:
❑ Schedule A -1 - Investments — schedule attached XSchedule C - Income, Loans, & Business Positions — schedule attached
Schedule A -2 - Investments — schedule attached ❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or-
❑ None - No reportable interests on any schedule
5. Verification $ (�i)_Poq I CA q—,50Z0
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the
)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 666/275 -3772 www.fppc.ca.gov
SCHEDULE A -2 CALIFORNIA FORM 7001
Investments, Income, and Assets FAIR POLITICAL PRACTICES COMMISSION
of Business Entities /Trusts Name Name
(Ownership Interest is 10% or Greater)
HCY,A6,00 T2riORIFIA -1761✓ C 6ML-rAbo r:5
Name
Check one 7
❑ Trust, go to 2 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
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Property
FAIR MARKET VALUE
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $o - $1,999
❑ $10,OD1 - $100,000
❑ $z000 - $10,000
x-/12 J-/ t2
❑ $10,OD1 - $100,000
ACQUIRED DISPOSED
$100,001 - $1,000,000
NATURE OF INTEREST
F-1 Over $1,000,000
❑ Property Ownership /Deed of Trust
RE OF INVESTMENT
irtnership ❑ Sole Proprietorship ❑
YOUR BUSINESS POSITION 'AfZTiJr?Z.
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 OVER $100,000
❑ $1,001 - $10,000
None
Ctrl 0 i 1 ;1LRoy
Check one box.
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real
Property
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,OD1 - $100,000
_
❑ $100,001 - $1,000,000
ACQUIRED DISPOSED
❑ Over $1,0130,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust
❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 JJ 12 _/_/ 12
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,OOo
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
❑ $0 - $499
❑ $500 - $1,000
❑ $TOol - $10,000
None
❑ $10,001 . $100,000
❑ OVER $100,000
uneck one oox:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE
❑ $2,000 - .$10,000
❑ $10,001 - $10o,000
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust
IF APPLICABLE, LIST DATE:
_ /_/ 12 __/__J_12
ACQUIRED DISPOSED
❑ Stock ❑ Partnership
❑ Leasehold Yrs E3 Other
. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 (2012/2013) Sch. A -2
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free helpline: 866 /275 -3772 www.fppc.ca.gov
SCHEDULE C CALIFORNIA]FORM IfIll
Income, Loans, & Business FAIR POLITICAL
Positions Name
(Other than Gifts and Travel Payments) J Jf,
NAME OF SOURCE OF INCOME
"(5YA(rrtt t Wt ;PUPrAT /d W (6W0L,—iov7-5
ADDRESS (Business Address Acceptable)
t;AN -AX5F e-A 9511 -3
BUSINESS ACTIVITY, IF ANY, OF SOURCE
( N590L'npCY-
YOUR BUSINESS POSITION
'Pki QC+P 0, t,
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,00l - $10,00o
❑ $10,001 - $100.000 Eg,OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED -
0 Salary ❑ Spouse's or registered domestic partner's income
❑ Loan repayment Partnership
❑ Sale of
(Real property, car,
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
( Descrbe)
2. LOANS RECEIVED 012 OUTSTANDING DURING THE REPORTING PERIOD
You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street atltlress
❑ Guarantor
❑ Other
City
(Describe)
FPPC Form 700 (2012/2013) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866 /275 -3772 v .fppc.ca.gov