Hexagon Transportation - Annual 2013CALIFORNIA FORM 1 1 STATEMENT OF ECONOMIC INTERESTS
POLITICAL FAIR
DOCUMENT A PUBLIC COVER PAGE ?0
Please type or print in ink. � for r `
Date Received
Offioal Use Only
NAME OF FILER (LAST) (FIRST) 1: (MIDDLE)
EL_ l \ SFrF K -E ,A (. A ti(
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
L 1 7-y OF ur I L.rz.p j' 0 x L TA �J T
Division, Board, Department, District, if applicable Your Position
F NCrIPEe t'_tr GT , ri-Apt ,tik
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi- County
(City of
i t- rZ f '(
❑ 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, 2013, through ❑ Leaving Office: Date Left I I
December 31, 2013, (Check one)
.or-
The period covered is I I through
December 31, 2013.
❑ Assuming Office: Date assumed —J
❑ Candidate: Election year
O The period covered is January 1, 2013, through the date of
leaving office.
O The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1:
4. Schedule Summary S
Check applicable schedules or "None." ► Total number of pages including this cover page:
❑ Schedule A -1 - Investments – schedule attached ;< Schedule C - Income, Loans, & Business Positions – schedule attached
J< 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 GnLROY, CA 95oZ 0
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
oS ) g 4-G — 741
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(2013/2014)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE A -2
Investments, Income, and Assets
of Business Entities /Trusts
(Ownership Interest is 10% or Greater)
1p- 1. BUSINESS ENTITY OR TRUST
1,AE?,A%00
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
`rRAWSf��Ill'r0tJ p44W IP- k /rty1%NC5Gle"I'lr
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $o - $1,999
❑ $2,000 - $10,000 _j --- j 13 � / 13
❑ $10,001 - $100,000 ACQUIRED DISPOSED
$100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION r.a�rNc�
10- 2. IULATIFT TAE GROSS I ek 0, it A Ilk
SHARE OF -• SS INCOME TO
❑
$0-$499 ❑ $10,001 - $100,000
❑ $500 - $1,000 OVER $100,000
❑ $1,001 - $10,000
po. 3. LIST THE NAME OF -•- TABLE SINGLE SOURCE OF
INCOME OF i00 OR •
❑ None
C rry of GrrL20 j
PROPERTY 0- 4. INVESTMENTS AND INTERESTS IN REAL . •-
LEASED : OR
one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, gl
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity gj
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 /__j 13 if /13
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
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
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Do- 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 �� 13 _/ /13
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
SHARE OF -• SS INCOME LO THE ENTITY/TRUST)
❑ $0-$499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
P� 3. LIST THE NAME OF ••- TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (A"ach a separate sheet if necessary.)
None
PROPERTY 0 4. INVESTMENTS AND INTERESTS IN REAL . •-
•-
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, 91
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity Qr
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 3
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
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
Comments: FPPC Form 700 (2013/2014) 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
Income, Loans, & Business FAIR POLITICAL PRACTICES C4
Positions Name
(Other than Gifts and Travel Payments) j eaF(< F t_A
NAME OF SOURCE OF INCOME
�>✓� aG e � Tf'o �� T�or� � 1v5� c7�w rYi, (N C
ADDRESS (Business Address Acceptable)
�tnj_)05r,C/A95t1a
BUSINESS ACTIVITY, IF ANY, OF SOURCE
l F Nye L_7tN6 -
YOUR BUSINESS POSITION
Pte % PC^ (_
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
9 Salary ❑ Spouse's or registered domestic partner's income
❑ Loan repayment Partnership
F7 _q, o of
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
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 - $100,000 ❑ 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
(Describe)
* 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
❑ Guarantor
❑ Other
Street address
city
(Describe)
FPPC Form 700 (2013/2014) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov