Nassau County, NY · Nassau County
Disclosure Form for a Nassau County License
This disclosure form collects background and experience information from people applying for or associated with a Nassau County home improvement business license.
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
The form is for each individual owner, partner, officer, principal, director, technician, stockholder, sales representative, manager, foreman, or other person who negotiates with consumers or signs contracts for the business. It asks about personal details, relevant work experience, and specified legal and financial matters. Applicants must provide supporting documents for certain answers and agree to notify Consumer Affairs about specified business changes.
Who needs it
Each listed business owner or representative who negotiates with consumers or signs contracts on the business’s behalf completes the disclosure.
How to submit it
Submit the form to the Nassau County Department of Consumer Affairs at 240 Old Country Road, Mineola, NY 11501. The form also lists [email protected] and (516) 571-2600.
About notarization
This document is signed without a notary; the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Nassau County disclosure form.
- 2
Complete the Form
Type or print clearly in black or blue ink, answer every question, and provide details about relevant home improvement experience.
- 3
Gather Supporting Documents
Include W-2s or 1099s to show experience and any supporting records required for your answers.
- 4
Submit to the Department
Send the completed form to the Nassau County Department of Consumer Affairs at the address shown on the form.
Frequently asked questions
- What is the Nassau County home improvement disclosure form?
- It collects personal, work experience, and background information from people associated with a business applying for a Nassau County license.
- Who must complete this disclosure form?
- Each individual owner, partner, officer, principal, director, technician, stockholder, sales representative, manager, foreman, or other person who negotiates with consumers or signs contracts for the business.
- Do I need a notary for the Nassau County disclosure form?
- No. This document is signed without a notary; the signer just signs and dates it.
- How do I submit the Nassau County disclosure form?
- Submit it to the Nassau County Department of Consumer Affairs at 240 Old Country Road, Mineola, NY 11501. The form also lists an email address and phone number.