What information does the Supplemental Questionnaire ask for?

It asks about controlling persons, residential addresses, employment history, additional owners and officers, and specified background information.

Who should complete this questionnaire?

The form requests information about controlling persons with 10% or greater ownership interest or earnings, as well as additional owners and officers.

Do I need a notary for the Supplemental Questionnaire?

No. The form has a signature and certification section but no notary block; the signer prints their name, signs, and dates it.

How do I submit the Supplemental Questionnaire?

The form lists the Licensing Office mailing address as PO Box 1466, Mesa, Arizona 85211-1466, and a street address of 55 North Center Street, Mesa, Arizona.

Mesa, AZ · Maricopa County

No notary required

Massage & Bodywork Establishment License Supplemental Questionnaire

This questionnaire collects ownership, address, employment, and background information from people associated with a Massage and Bodywork Establishment License request.

What this form is

The City of Mesa's supplemental questionnaire gathers information about controlling persons, additional owners and officers, residential addresses, employment history, and background. It also includes consent for a background investigation and a certification section. The form states that incomplete answers may be cause for denial of the license request and asks the signer to provide truthful, complete information.

Who needs it

People listed as controlling persons with at least 10% ownership or earnings, and other owners or officers, provide information on this questionnaire.

How to submit it

The form lists the Licensing Office at PO Box 1466, Mesa, Arizona 85211-1466, and 55 North Center Street, Mesa, Arizona. It also lists a telephone number and fax number.

About notarization

This document is signed without a notary; the signer prints their name, signs, and dates the certification.

How to submit this form

1
Download The Questionnaire
Download the Massage & Bodywork Establishment License Supplemental Questionnaire PDF.
2
Complete The Form
Fill in the requested ownership, address, employment, and background information.
3
Review And Sign
Review your answers, then print your name, sign, and date the certification.
4
Submit To The Licensing Office
Use the Licensing Office address listed on the form.

Frequently asked questions

What information does the Supplemental Questionnaire ask for?: It asks about controlling persons, residential addresses, employment history, additional owners and officers, and specified background information.
Who should complete this questionnaire?: The form requests information about controlling persons with 10% or greater ownership interest or earnings, as well as additional owners and officers.
Do I need a notary for the Supplemental Questionnaire?: No. The form has a signature and certification section but no notary block; the signer prints their name, signs, and dates it.
How do I submit the Supplemental Questionnaire?: The form lists the Licensing Office mailing address as PO Box 1466, Mesa, Arizona 85211-1466, and a street address of 55 North Center Street, Mesa, Arizona.

Need something notarized?

This Massage & Bodywork Establishment License Supplemental Questionnaire doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.