Who uses the Nassau County ATM Registration Form?

An ATM owner or operator uses it to register or renew registration for one ATM at a non-bank location.

What documents must accompany the application?

The form lists a copy of the operation or lease agreement between the store and owner or operator, if not already filed, and proof of ATM ownership.

Do I need a notary for the ATM Registration Form?

No. The form calls for a signature and date, not notarization. It lists an operation or lease agreement and proof of ATM ownership as attachments, without stating that they must be notarized.

How do I submit the ATM Registration Form?

Mail it with a $180 check payable to COUNTY OF NASSAU and the listed attachments to Nassau County Department of Consumer Affairs, 240 Old Country Rd, Mineola, NY 11501, Attn: ATM Administrator.

Nassau County, NY · Nassau County

No notary required

ATM Registration Form

Nassau County ATM owners or operators use this form to register or renew registration for one ATM at a non-bank location.

At a glance

Issued by: City of Nassau County · Nassau County, Nassau County, New York
Notarization: Not required: file this form without a notary.
Official source: nassaucountyny.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form is for registering or renewing registration for one ATM with the Nassau County Department of Consumer Affairs. It asks for the ATM location, owner or operator, servicing agent, machine details, transaction types, and EFT institution. The application requests a $180 check and specified supporting documents.

Who needs it

An owner or operator registering or renewing registration for an ATM at a non-bank location in Nassau County needs this application.

How to submit it

Mail the application, a $180 check payable to COUNTY OF NASSAU, and the listed supporting documents to Nassau County Department of Consumer Affairs, 240 Old Country Rd, Mineola, NY 11501, Attn: ATM Administrator.

About notarization

This document is signed and dated without a notary; the listed operation or lease agreement and proof of ATM ownership are attachments, with no notarization stated.

How to submit this form

1
Download the Form
Download the ATM Registration Form for the year shown on the application.
2
Complete the Application
Complete all sections for one ATM, including its location, owner or operator, servicing agent, and ATM information.
3
Gather the Attachments
Include the operation or lease agreement between the store and owner or operator, if not already filed, and proof of ATM ownership.
4
Prepare the Check
Include a $180 check payable to COUNTY OF NASSAU.
5
Mail to the Department
Mail the application and attachments to Nassau County Department of Consumer Affairs, 240 Old Country Rd, Mineola, NY 11501, Attn: ATM Administrator.

Frequently asked questions

Who uses the Nassau County ATM Registration Form?: An ATM owner or operator uses it to register or renew registration for one ATM at a non-bank location.
What documents must accompany the application?: The form lists a copy of the operation or lease agreement between the store and owner or operator, if not already filed, and proof of ATM ownership.
Do I need a notary for the ATM Registration Form?: No. The form calls for a signature and date, not notarization. It lists an operation or lease agreement and proof of ATM ownership as attachments, without stating that they must be notarized.
How do I submit the ATM Registration Form?: Mail it with a $180 check payable to COUNTY OF NASSAU and the listed attachments to Nassau County Department of Consumer Affairs, 240 Old Country Rd, Mineola, NY 11501, Attn: ATM Administrator.

Need something notarized?

This ATM Registration Form doesn’t need a notary, but if you have another Nassau County form that does, a commissioned online notary can help.