Mesa, AZ · Maricopa County
Community Residence Registration Application
Facility applicants use this application to register a community residence, assisted living facility, or nursing and convalescent home with the City of Mesa.
What this form is
This application collects information for registering a community residence, assisted living facility, or nursing and convalescent home with the City of Mesa. It asks for the facility type, resident count, tenancy length, license or certification details, facility and operator contacts, and property owner information. The property owner and applicant provide signatures and dates and the applicant affirms the accuracy of the submitted information.
Who needs it
Applicants registering a community residence, assisted living facility, or nursing and convalescent home with the City of Mesa need this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; it lists no notarized or sworn attachment, so the property owner and applicant sign and date it.
How to submit this form
- 1
Download The Application
Download the Community Residence Registration Application PDF.
- 2
Complete Facility Details
Enter the facility type, resident count, tenancy length, license or certification details, and facility and operator contact information.
- 3
Complete Owner Information
Provide the property owner information and have the property owner sign and date the form.
- 4
Sign And Submit
Complete the applicant affirmation, sign and date the application, and submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Community Residence Registration Application?
- No. The application has signature and date fields but no notary block or notarized attachment listed; the property owner and applicant sign and date it.
- How do I submit the Community Residence Registration Application?
- Submit it to the city department named on the form; check the city website for current contact details.
- What information does the application ask for?
- It asks for facility type and details, resident count, tenancy length, license or certification information, facility and operator contacts, property owner information, and applicant affirmation.
Need something notarized?
This Community Residence Registration Application doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.