Commercial Residential

Yes No

Initial Application Annual Renewal Amendment to License

Individual Partnership Corporation

Yes No

Acknowledged

Required Documents

Street Address *

Last Name *

Select An Address *

Phone # *

The applicant hereby affirms that all massage, bodywork and somatic therapist employed or to be employed by the establishment or otherwise permitted to work at the establishment have been licensed by the State of New Jersey pursuant to the Massage and Bodywork Therapist Licensing Act, P.L. 1999 amended 2007, c. 337.

(Total % must equal 100%) *

State *

Add a record for each manager or other person principally in charge of the operations of the business, as well as all massage, bodywork, and somatic therapists and employees of the business:

First Name *

Property Owner Information

Employee Information

ZIP *

References

Phone # *

Application Type *

First Name *

Mailing Address

Parcel ID

Acknowledgment *

Name Under Which Business Will Be Conducted *

City *

Establishment Information

Fee Schedule

I/We the undersigned, do hereby affirm that the statements in the application are true and correct and also agree to comply with the provisions of Chapter 296 of the Code of the Township of Hamilton, NJ, including but not limited to an investigation into the criminal history record background by the Hamilton Township Police Division of any person applying for a permit.

I hereby further certify that all massage, bodywork and somatic therapists employed or to be employed by this establishment or otherwise permitted to work at the establishment have been licensed by the State of New Jersey pursuant to the Massage and Bodywork Therapist Licensing Act, P.L. 1999, c. 19

Agent Address

Total Ownership %

Email Address *

Business History

Phone # *

First Name *

Website (If Applicable)

Street Address *

Application Fee

State *

Email

Business Address

Mailing City, State, ZIP

State *

An Outline Of The Fees Associated with This Permit Can Be Found here.

Do You Own This Property?

City *

ZIP *

Exact Nature Of The Services To Be Offered At This Establishment. *

Business Owner Information

Attach the following documents below for each employee working at the establishment: *

• Two (2) 2" x 2" Front-Face Passport Photos Taken Within 30 Days Of Application Date
• Copy of Federal Employee Identification Number (if applicable)
• Copy of NJ Tax & Employer Business Registration
• Copy of NJ Massage & Bodywork Therapist License for Each Employee
• Copy of NJ Massage & Bodywork Therapist Employer Registration
• Copy of Driver's License

Add a record concerning the applicant(s), if an individual; each stockholder holding more than 10% of stock of the corporation; each officer and each director if the applicant is a corporation; the partners, including limited partners, if the application is a partnership; the manager or other person principally in charge of the operation of the business.

Phone #

Applicant Signature *

Please set forth any massage therapy or similar business history and experience, to include, but not limited to, whether or not such person has previously operated in this or another municipality or state under a license or permit or has had such license or permit denied, revoked or suspended and the reason therefor and the business activities or occupations subsequent to such action or denial, suspension or revocation.

Street Address *

Agent Name

ZIP *

Last Name *

Last Name *

Provide the names and addresses of three adult residents who will serve as character reference (no business associates or relatives).

Certification

Name

Days And Times Operation Will Be Open To The Public. *

Phone # *

Ownership *

City *