Vendor Claim Forms

Nassau County Comptroller Lobby

VENDOR CLAIM FORMS 

Claim vouchers/invoices should be mailed to the Nassau County department that has received the goods or services. A step-by-step guide to completing each claim voucher is found on the back of each document.  

Fillable PDF Claim Forms

Claim Voucher PDF Fillable (Non-Capital)

Claim Voucher PDF Fillable (Capital)

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Printable PDF Claim Forms

Claim Voucher PDF to Print (Capital)

Claim Voucher (Non-Capital)

 

 THE CLAIMANT’S CERTIFICATION 

If you do not have a contract with Nassau County that requires the use of a claim voucher, and wish to use your own invoice/voucher, the following ‘Claimant’s Certification’ disclosure statement must be included in your invoice or claim for payment.

Insert or attach the certification statement below to your invoice. [Claimant's Certification is available here as a PDF.

I hereby certify that this claim voucher is just, true, and correct; that the amount claimed is actually due and owing and has not been previously claimed; that no taxes from which the County is exempt are included; and that any amounts claimed for disbursements have actually and necessarily been made. I further certify that all items and/or services were delivered or rendered as set forth in this claim, and for all items and/or services delivered or rendered in accordance with a purchase order or contract that the prices charged are in accordance with the reference purchase order or contract. For all claims made as reimbursement for employee expenses, I further certify that the amounts set forth were actually and necessarily expended for the benefit of Nassau County, and that the monies expended have not been reimbursed nor do I expect to be reimbursed from any other source.

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Sign

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