Nassau County, NY · Nassau County
Duplicate License Request Form
Business license holders use this form to request a duplicate license from the Nassau County Department of Consumer Affairs.
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
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to request a duplicate business license to be printed and mailed to your business mailing address. The request requires the business name and license number, contact and mailing details, the reason for the request, and a principal or owner’s signature and date. The document also lists current insurance certificates and a $60 payment among the required items.
Who needs it
A licensed business whose principal or owner needs a duplicate license printed and mailed should complete this request form.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This form is signed and dated by a principal or owner without a notary; it requires current insurance certificates and payment, but mentions no sworn or notarized attachment.
How to submit this form
- 1
Download the Form
Download the Duplicate License Request Form.
- 2
Complete the Request
Enter the licensed business’s details, contact information, mailing address, and reason for requesting a duplicate.
- 3
Gather Required Items
Include the current insurance certificates or applicable CE-200 waiver, and a $60 payment in an accepted form.
- 4
Sign and Submit
Have a company principal or owner sign and date the form, then submit it to the county department named on the form.
Frequently asked questions
- Do I need a notary for the Duplicate License Request Form?
- No. A principal or owner signs and dates this form without a notary. It calls for current insurance certificates and payment, but does not mention a sworn or notarized attachment.
- How do I submit the Duplicate License Request Form?
- The document does not specify a submission method. Submit it to the Nassau County Department of Consumer Affairs and check the county website for current contact details.
- What must I include with my duplicate license request?
- The form lists current business liability insurance and workers’ compensation insurance, or a signed CE-200 waiver if there are no employees, plus a business check, certified bank check, or money order for $60.
- Who must sign the request?
- A principal or owner of the company must sign and date the Duplicate License Request Form.