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Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)
700 S Third St, Las Vegas, NV, 89101 702-388-9600
Mailing Address (include city and zip code) Telephone No.
 
E-Mail Address

 Select Appropriate Box(es)		 CANDIDATE PAC POL PRTY IND EXP NONPROFIT CORP
LEGAL DEFENSE FUND AMENDED LOCAL BAG
Annual Filing - Due January 15, 2010
Period: Jan 01, 2009 - Dec 31, 2009
Report #1 - Due June 01, 2010*
Period: Jan 01, 2010 - May 27, 2010
Report #2 - Due October 26, 2010*
Period: May 28, 2010 - Oct 21, 2010
Report #3 - Due January 15, 2011*/**
Period: Oct 22, 2010 - Dec 31, 2010
Annual Filing - Due January 15, 2011
Period: Jan 01, 2010 - Dec 31, 2010
FILE
Jan 13 2010
 
ROSS MILLER
SECRETARY OF STATE
FOR OFFICE USE ONLY
      * These Reports are filed by incumbents/candidates in the 2010 election cycle
      ** Third Report suffices for 2011 Annual Filing if candidate also filed Report Nos. 1 and 2
1. Total Monetary Contributions Received in Excess of $100
    (See page 1 of instruction sheet) 		$ 31,450.00   $ 31,450.00
2. Total Monetary Contributions in the form of loans guaranteed by a third
    party.  (See page 1 of instruction sheet) 		$ 0.00   $0.00
3. Total Monetary Contributions in the form of loans that were forgiven
    (See page 2 of instruction sheet) 		$ 0.00   $0.00
4. Total Amount of Monetary Contributions Received
    (Add Lines 1 through 3)  (See page 2 of instruction sheet) 		$ 31,450.00   $31,450.00
5. Total Amount of Written Commitments for Contributions
    (When commitment is funded, report as contribution (monetary or in kind))
    (See page 2 of instruction sheet)
$ 0.00   $0.00
6. Total Value of In Kind Contributions Received in
    Excess of $100   (See page 2 of instruction sheet) 		$ 0.00   $0.00
 
7. Total Monetary Expenses Paid in Excess of $100
    (See page 2 of instruction sheet) 		$ 24,722.76   $24,722.76
8. Total Value of In Kind Expenses in Excess
    of $100  (See page 2 of instruction sheet) 		$ 0.00   $0.00
 
I Declare Under Penalty of Perjury That the Foregoing is True and Correct.

Richard Segerblom 01/13/2010
Signature Date
 

 CAMPAIGN CONTRIBUTIONS Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

Contributions in Excess of $100 or, When Added Together from One Contributor Exceeds $100
Transfer Total Amount of All Campaign Contributions to Line 1 of Contributions Summary
 CONTRIBUTOR'S NAME AND
ADDRESS		 DATE OF EACH
CONTRIBUTION 		 AMOUNT OF EACH
CONTRIBUTION		 CHECK
HERE
IF LOAN		 NAME AND
ADDRESS OF
3rd PARTY IF
LOAN
GUARANTEED
BY 3rd PARTY		 NAME AND ADDRESS
OF PERSON WHO
FORGAVE THE LOAN,
IF DIFFERENT THAN
CONTRIBUTOR
Robert C. Maddox and Associates
10587 Double R. Blvd.
Suite 100
Reno, NV 89521		01/02/2009$500.00   
Wiliam Patterson Cashill Attorney and Counsellor at Law
410 California Avenue
Reno, NV 89509		01/02/2009$500.00   
Citizens for Justice Trust
406 N Nevada Street
Carson City, NV 89703-4107
01/02/2009
11/23/2009
$1,000.00
$1,500.00
   
Scott K. Kanepa
851 S. Rampart Blvd.
Suite 160
Las Vegas, NV 89145		01/02/2009$500.00   
Richard Segerblom
704 S. 9th Street
Las Vegas, NV 89101		07/21/2009$5,000.00X  
Barrick Goldstrike
136 East South Temple
Suite 1800
Salt Lake City, UT 84111
08/03/2009
11/05/2009
$500.00
$1,000.00
   
Southern Nevada Conference of Police and Sherriffs' Polication Action Fund
9330 W. Lake Mead Blvd.
Suite 120
Las Vegas, NV 89134		08/13/2009$1,000.00   
Michael A. Nasiak
11071 Colony Creek Lane
Las Vegas, NV 89135		09/17/2009$500.00   
Altria Client Services
6601 W. Broad St.
Richmond, VA 23230		09/17/2009$750.00   
Associated General Contractors
150 N. Durango
Suite 100
Las Vegas, NV 89145		10/16/2009$1,500.00   
Richard Segerblom
700 S. Third St.
Las Vegas, NV 89101
10/21/2009
12/23/2009
$2,000.00
$5,000.00
X  
Nevada Mining Assocation
9210 Prototyp Drive
Suite 200
Reno, NV 89521		10/28/2009$1,000.00   
Nevada Faculty Alliance
6375 W. Charleston Blvd W10H
Las Vegas, NV 89146		11/01/2009$200.00   
Ran Services, Inc
410 S. Minnesota St.
Carson City, NV 89703		11/23/2009$500.00   
Feinberg Grant Mayfield Kaneeda & Litt, LLP
1955 Village Center Circle
Las Vegas, NV 89134		11/25/2009$2,000.00   
Gene Segerblom
P.O. Box 61136
Boulder City, NV 89006		12/07/2009$1,000.00   
R&R Partners, Inc.
900 S. Pavillion Center
Las Vegas, NV 89144		12/17/2009$1,000.00   
Nevada Power Company
6226 W. Sahara Ave.
Las Vegas, NV 89146		12/17/2009$1,000.00   
Newmont
1700 Lincoln Street
Ste 3600
Denver, CO 80203		12/21/2009$1,000.00   
Professional Firefighters of Nevada
P.O. Box 364269
N. Las Vegas, NV 89036		12/27/2009$500.00   
Searchlight Leadership Fund
607 14th Street NW Suite 800
Washington, DC 20005		12/29/2009$1,000.00   
R&S Investment Properties
979 Camelia Dr.
Henderson, NV 89015		12/29/2009$1,000.00   

This page may be copied or duplicated if additional space is needed.

 

 WRITTEN COMMITMENTS Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

Written Commitments in Excess of $100 or, When Added Together from One Entity Exceeds $100
Transfer Total Amount of All Written Commitments to Line 5 of Contributions Summary
 NAME AND ADDRESS OF PERSON WHO
MADE THE COMMITMENT		 DATE OF EACH
COMMITMENT 		 AMOUNT OF EACH
COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

This page may be copied or duplicated if additional space is needed.

 

 CAMPAIGN EXPENSES Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

Expense Categories

 CATEGORIES  CODE
 Office expenses A
 Expenses related to volunteers B
 Expenses related to travel C
 Expenses related to advertising D
 Expenses related to paid staff E
 Expenses related to consultants F
 Expenses related to polling G
 Expenses related to special events H
 ** Goods and services provided in kind for which money would otherwise
   have been paid 		I
 Other miscellaneous expenses J










** NRS 294A.362 requires “In Kind” contributions and expenses to be reported on a separate form, which is attached.
 

 CAMPAIGN EXPENSES Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

Expenses in Excess of $100
Transfer Total Amount of All Campaign Expenses to Line 7 of Expenses Summary
 NAME AND ADDRESS OF
 PERSON, GROUP OR
 ORGANIZATION WHO RECEIVED
 THE PAYMENT FOR THE
 EXPENSE(S)		CATEGORY
(See Previous Page)

NRS 294A.365		DATE OF EACH
EXPENSE 		AMOUNT OF
EACH EXPENSE
Passkey Systems
4395 Polaris Ave
Las Vegas, NV 89103
D
D
01/08/2009
12/30/2009
$1,780.58
$3,649.43
Jane Lyon
874 Shirley Lane
Boulder City, NV 89005		E01/14/2009$200.00
Assembly Democratic Caucus
2251 N Rampart 341
Las Vegas, NV 89129		J02/23/2009$1,500.00
Brewery Art Center
449 W. King Street
Carson City, NV 89703		J05/25/2009$125.00
Adeles Restaurant
1112 N. Carson Street
Carson City, NV 89701		J06/05/2009$407.03
An Evening With Class
3570 Las Vegas Blvd South
Las Vegas, NV 89109		H06/11/2009$250.00
Print Merchants
1337 Denver St.
Boulder City
Las Vegas, NV 89005		D07/20/2009$103.78
Jennifer Breeden
2070 Angel Falls Dr.
Las Vegas, NV 89074		E07/24/2009$3,000.00
NAACP - Las Vegas Branch 1111
3340 South Topaz St.
Suite 150
Las Vegas, NV 89121		J08/10/2009$100.00
Southwest Airlines
PO Box 36647
Dallas, TX 75235
C
C
C
08/13/2009
09/04/2009
09/08/2009
$278.40
$319.20
$319.20
@dvocacy Inc.
1001 G Street
Suite 460-A West
Washington, DC 20001		D10/20/2009$145.42
Las Vegas Review Journal
1111 W. Bonanza Road
Las Vegas, NV 89106		J10/20/2009$257.40
Elliot Kleven
3973 Mojado Ct.
Las Vegas, NV 89121		J10/20/2009$110.26
ACLU Celebration of Civil Liberties
5160 Las Vegas Blvd South
Las Vegas, NV 89117		H10/20/2009$100.00
NCSL Redistricting Seminar
7700 E. First Place
Denver, CO 80230		H10/22/2009$495.00
the westin michigan avenue
909 North Michigan Avenue
Chicago, IL 60611		H10/22/2009$760.84
Time Printing
1224 Western Ave
Las Vegas, NV 89102
A
D
10/26/2009
12/23/2009
$178.00
$4,327.28
Costco Wholesale
791 Marks Street
Las Vegas, NV 89014		H11/20/2009$396.47
Paymons
107 E. Charleston
Las Vegas, NV 89104		J11/30/2009$108.72
Warren Dang
6584 Holly River St.
Las Vegas, NV 89148		E12/15/2009$3,000.00
Sula Jung
4480 Spring Mountain Road #4
Las Vegas, NV 89102		J12/16/2009$134.75
Woodhouse for Senate
246 Garfield Dr.
Henderson, NV 89074		J12/28/2009$1,000.00
Legal Aid Center
800 South 8th Street
Las Vegas, NV 89101-7051		J12/28/2009$1,000.00
United States Post Office
201 Las Vegas Blvd.
Suite 100
Las Vegas, NV 89101		A12/30/2009$176.00
Peterson for Senate
3773 Howard Hughes Pkwy.
3rd Floor
Las Vegas, NV 89109-0949		J12/30/2009$500.00
 
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 IN KIND CONTRIBUTIONS AND EXPENSES REPORT




IN KIND CONTRIBUTION IS DEFINED AS THE VALUE OF SERVICES PROVIDED IN KIND FOR WHICH MONEY WOULD HAVE OTHERWISE BEEN PAID.
In kind contributions and expenses include: paid polling and resulting data, paid direct mail, paid solicitation by telephone, any paid paraphernalia that was printed or otherwise produced to promote a campaign and the use of paid personnel to assist in a campaign. An in kind contribution may also include, but is not limited to: goods and services such as billboards, office space, printing, food and beverage and yard signs.

The donor of in kind contributions shall furnish to the recipient (candidate or other person), a written statement setting forth the actual cost of those services or the fair market value within 30 days after the time he furnishes those services. (NAC 294A.043)

Examples of in kind contributions: (1) A person contributes billboard space and does not charge the candidate. The candidate would report the fair market value or actual cost of the billboard space as an in kind contribution; (2) A person pays for the printing cost of political signs for a candidate. The candidate would report the actual cost or fair market value of printing the signs as an in kind contribution.

Example of in kind expenses: (1) A person contributes the use of a large room to a candidate as an in kind contribution. Once the candidate utilizes the room it becomes an in kind expense to be reported.
 

 IN KIND CAMPAIGN
CONTRIBUTIONS 		Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

IN KIND
Contributions in Excess of $100 or, When Added Together from One Contributor Exceeds $100
Transfer Total Value of All In-Kind Campaign Contributions to Line 6 of Contributions Summary
 CONTRIBUTOR'S
NAME AND
ADDRESS		 DATE OF
EACH
IN KIND
CONTRI-
BUTION 		 DESCRIPTION OF
EACH
IN KIND
CONTRIBUTION		 VALUE OR COST
OF EACH
IN KIND
CONTRIBUTION/
COMMITMENT		 CHECK
HERE
IF
LOAN		 NAME AND
ADDRESS OF 3rd
PARTY IF LOAN
GUARANTEED
BY 3rd PARTY		 NAME AND
ADDRESS OF
PERSON WHO
FORGAVE THE
LOAN
       
       
       
       
       
       
       
       
       
       
       
       
       





This page may be copied or duplicated if additional space is needed.

 

 IN KIND
WRITTEN COMMITMENTS 		Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

In Kind Written Commitments in Excess of $100 or, When Added Together from One Entity Exceeds $100
Transfer Total Amount of All Written Commitments to Line 5 of Contributions Summary
 NAME AND ADDRESS OF PERSON WHO
MADE THE IN KIND COMMITMENT		 DATE OF EACH
IN KIND
COMMITMENT 		 AMOUNT OF EACH
IN KIND
COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

This page may be copied or duplicated if additional space is needed.

 

 IN KIND CAMPAIGN
EXPENSES 		Report Period   # An.
Richard "Tick" Segerblom State Assembly, District 9 9
Name (print) Office (if applicable) District (if applicable)

IN KIND
Expenses in Excess of $100
Transfer Total Value of All In-Kind Campaign Expenses to Line 8 of Expenses Summary

This page may be copied or duplicated if additional space is needed.

Prescribed by Secretary of State
NRS 294A.120, 294A.125,
294A.140, 294A.150, 294A.160
294A.200, 294A.210, 294A.220, 294A.362