{"id":1055,"date":"2022-08-08T13:27:19","date_gmt":"2022-08-08T17:27:19","guid":{"rendered":"https:\/\/azurformulaire.com\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/"},"modified":"2026-10-23T07:22:54","modified_gmt":"2026-10-23T11:22:54","slug":"consent-to-the-disclosure-of-personal-information-to-a-third-party","status":"publish","type":"page","link":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/","title":{"rendered":"Consent to the disclosure of personal information to a third party"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1055\" class=\"elementor elementor-1055 elementor-273\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8bab587 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"8bab587\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-39c36bc e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-child\" data-id=\"39c36bc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3810da0 elementor-widget elementor-widget-htwpform-addons\" data-id=\"3810da0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"htwpform-addons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t            <div class=\"htwpform_area\" >\n                <div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-5739\"><form id=\"wpforms-form-5739\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"5739\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/1055\" autocomplete=\"nope\" data-token=\"5e806ccaca9294067f7f7963d4fdb576\" data-token-time=\"1792861011\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Consent to disclose information to a third party<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-5739-field_51-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"51\"><div class=\"wpforms-field-description\">Funeral Director: Denis Lachance<\/div><\/div><div id=\"wpforms-5739-field_23-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"23\"><h3 id=\"wpforms-5739-field_23\">Deceased Person&#039;s Information<\/h3><\/div><div id=\"wpforms-5739-field_0-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-type=\"name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_0\">Family name at birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-5739-field_86-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half\" data-field-type=\"name\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_86\">First name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_86\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][86]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-5739-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_3\">Other first names (Separate each first name with a comma)<\/label><input type=\"text\" id=\"wpforms-5739-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\" placeholder=\"Other first names\" ><\/div><div id=\"wpforms-5739-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-5739-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_19_1\" name=\"wpforms[fields][19]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_19_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_19_2\" name=\"wpforms[fields][19]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_19_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-5739-field_71-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-type=\"date-time\" data-field-id=\"71\"><label class=\"wpforms-field-label\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][71][date][d]\" id=\"wpforms-5739-field_71-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][71][date][m]\" id=\"wpforms-5739-field_71-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][71][date][y]\" id=\"wpforms-5739-field_71-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-5739-field_87-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"87\"><label class=\"wpforms-field-label\">Date of death<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][87][date][d]\" id=\"wpforms-5739-field_87-day\" class=\"wpforms-field-date-time-date-day\" ><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][87][date][m]\" id=\"wpforms-5739-field_87-month\" class=\"wpforms-field-date-time-date-month\" ><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][87][date][y]\" id=\"wpforms-5739-field_87-year\" class=\"wpforms-field-date-time-date-year\" ><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-5739-field_42-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"42\"><h3 id=\"wpforms-5739-field_42\">Information about the person reporting the death<\/h3><\/div><div id=\"wpforms-5739-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"43\"><label class=\"wpforms-field-label\">Status of the declarant (Responsible person) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-5739-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_43_1\" name=\"wpforms[fields][43]\" value=\"Civil union spouse\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_43_1\">Civil union spouse<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_43_2\" name=\"wpforms[fields][43]\" value=\"Close relative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_43_2\">Close relative<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_43_3\" name=\"wpforms[fields][43]\" value=\"Ally (relative by marriage)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_43_3\">Ally (relative by marriage)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-5739-field_43_4\" name=\"wpforms[fields][43]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_43_4\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-5739-field_45-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"45\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-5739-field_45\">Quality of declarant, Precision <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_45\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][45]\" placeholder=\"Precision\" required><\/div><div id=\"wpforms-5739-field_46-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-type=\"name\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_46\">Last name at birth of the person filing the return <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_46\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-5739-field_85-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half\" data-field-type=\"name\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_85\">First name of the declarant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_85\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][85]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-5739-field_49-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_49\">Home telephone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_49\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][49]\" placeholder=\"(000) 000-0000\" required><\/div><div id=\"wpforms-5739-field_84-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-type=\"text\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_84\">Phone (Other number, e.g., cell phone) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_84\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][84]\" placeholder=\"(000) 000-0000\" required><\/div><div id=\"wpforms-5739-field_91-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_91\">Phone number to use to reach you <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_91\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][91]\" placeholder=\"(000) 000-0000\" required><\/div><div id=\"wpforms-5739-field_75-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_75\">E-mail<\/label><input type=\"email\" id=\"wpforms-5739-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-5739-field_99-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"99\"><h3 id=\"wpforms-5739-field_99\">Indicate authorized recipients (e.g., notary, lawyer, government agencies, etc.)<\/h3><\/div><div id=\"wpforms-5739-field_110-container\" class=\"wpforms-field wpforms-field-repeater wpforms-field-repeater-display-blocks\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"110\"><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][110][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-110-5739\"><div id=\"wpforms-5739-repeater-field_110-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<div class=\"wpforms-field-layout-rows wpforms-field-medium wpforms-field-repeater-display-blocks wpforms-field-repeater-preset-50-50\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_104_{CLONE}-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"104_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_104_{CLONE}\">Name of the representative <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_104_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][104_{CLONE}]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_105_{CLONE}-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"105_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_105_{CLONE}\">Company name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_105_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][105_{CLONE}]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_107_{CLONE}-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"107_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_107_{CLONE}\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5739-field_107_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][107_{CLONE}]\" aria-label=\"Phone\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_108_{CLONE}-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"108_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_108_{CLONE}\">Fax<\/label><input type=\"tel\" id=\"wpforms-5739-field_108_{CLONE}\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][108_{CLONE}]\" aria-label=\"Fax\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_109_{CLONE}-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"109_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_109_{CLONE}\">Email address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5739-field_109_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][109_{CLONE}]\" spellcheck=\"false\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-blocks-buttons\" data-button-type=\"buttons_with_icons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Ajouter<\/span>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Retirer<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-medium wpforms-field-repeater-display-blocks wpforms-field-repeater-preset-50-50\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_104-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_104\">Name of the representative <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_104\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][104]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_105-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"105\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_105\">Company name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5739-field_105\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][105]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_107-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"107\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_107\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5739-field_107\" class=\"wpforms-field-medium wpforms-field-required\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][107]\" aria-label=\"Phone\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_108-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_108\">Fax<\/label><input type=\"tel\" id=\"wpforms-5739-field_108\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][108]\" aria-label=\"Fax\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-5739-field_109-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"109\"><label class=\"wpforms-field-label\" for=\"wpforms-5739-field_109\">Email address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5739-field_109\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][109]\" spellcheck=\"false\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-blocks-buttons\" data-button-type=\"buttons_with_icons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Ajouter<\/span>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Retirer<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"wpforms-5739-field_115-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"115\"><h3 id=\"wpforms-5739-field_115\">Expenses<\/h3><\/div><div id=\"wpforms-5739-field_114-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"114\"><div id=\"wpforms-5739-field_114\">      <strong>155&nbsp;$ + tax<\/strong> \u2014 for sending and preparing documents.\r\n    \r\n    <li>\r\n      <strong>125&nbsp;$ + tax<\/strong> \u2014 for opening a file for:\r\n      <ul style=\"margin-top: 5px;\">\r\n        <li>Chrch<\/li>\r\n        <li>Cemetery<\/li>\r\n        <li>Columbarium<\/li>\r\n      <\/ul>\r\n    <\/li>\r\n  <\/div><\/div>\t\t<div id=\"wpforms-5739-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-5739-field_1\" >(notaries, authorize including<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-5739-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-5739-field_113-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"113\"><h3 id=\"wpforms-5739-field_113\">Consent to disclose information to a third party<\/h3><\/div><div id=\"wpforms-5739-field_98-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-type=\"checkbox\" data-field-id=\"98\"><label class=\"wpforms-field-label\">I, the undersigned, authorize Services Fun\u00e9raires Azur Incin\u00e9ration Inc. to disclose information relating to the death of the deceased named in the form to third parties (notaries, lawyers, banks, government agencies, etc.) for administrative and estate settlement purposes.  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-5739-field_98\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5739-field_98_1\" name=\"wpforms[fields][98][]\" value=\"I agree to the transmission of information in accordance with this consent.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_98_1\">I agree to the transmission of information in accordance with this consent.<\/label><\/li><\/ul><\/div><div id=\"wpforms-5739-field_102-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-type=\"gdpr-checkbox\" data-field-id=\"102\"><label class=\"wpforms-field-label\">By checking this box and clicking &quot;Submit&quot;, I authorize Services fun\u00e9raires Azur incin\u00e9ration inc. to collect, use, and disclose the personal information necessary to process my request and provide its services, in accordance with its Personal information protection policy and privacy policy. I also authorize Services fun\u00e9raires Azur to contact me by email and\/or text message (SMS) at the coordinates provided, notably for the follow-up of my request, service-related communications, notices, reminders, and operational notifications. My information may be transmitted to Azur partners when required for the provision of services, including crematoriums, cemeteries, suppliers, carriers, and relevant professionals. Message frequency may vary and message or data rates may apply. I can withdraw my consent to text messages at any time by replying STOP and get help by replying HELP. Consent to receive text messages is not a condition of purchase.       <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-5739-field_102\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-5739-field_102_1\" name=\"wpforms[fields][102][]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5739-field_102_1\">I agree.<\/label><\/li><\/ul><div class=\"wpforms-field-description\"><a href=\"https:\/\/www.azurformulaire.com\/politique-de-confidentialite\/\" target=\"_blank\">\nPersonal information protection policy and privacy policy\n<\/a><\/div><\/div><div id=\"wpforms-5739-field_70-container\" class=\"wpforms-field wpforms-field-divider wpforms-one-half wpforms-first\" data-field-type=\"divider\" data-field-id=\"70\"><h3 id=\"wpforms-5739-field_70\">Caution!<\/h3><div class=\"wpforms-field-description\">By clicking on the submit button below, I declare that I have carefully completed this questionnaire.<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-5739-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-5739-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-5739-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"5739\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792861011.ab3797b1d5f23f17b07604e661f57cfe74692ceaf66feda04dc66a47d1d6d31c\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages\/1055\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5739\" class=\"wpforms-submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->            <\/div>\n\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Consentement \u00e0 la communication de renseignements \u00e0 un tiersVeuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Directeur fun\u00e9raire : Denis Lachance Renseignements sur la personne d\u00e9c\u00e9d\u00e9e Nom de famille \u00e0 la naissance *Pr\u00e9nom *Autres pr\u00e9noms (S\u00e9parer chacun des pr\u00e9noms par une virgule)Sexe * Masculin F\u00e9minin Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Date du d\u00e9c\u00e8sJ12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 Renseignements sur le d\u00e9clarant du d\u00e9c\u00e8s Qualit\u00e9 du d\u00e9clarant (Personne responsable) * \u00c9poux ou conjoint d&#8217;union civile Proche parent Alli\u00e9 (parent par alliance) Autre Qualit\u00e9 du d\u00e9clarant, Pr\u00e9cision *Nom de famille \u00e0 la naissance du d\u00e9clarant *Pr\u00e9nom du d\u00e9clarant *T\u00e9l\u00e9phone au domicile *T\u00e9l\u00e9phone (Autre num\u00e9ro ex: mobile) *T\u00e9l\u00e9phone \u00e0 utiliser en priorit\u00e9 pour vous rejoindre *Courriel Indiquer les destinataires autoris\u00e9s (ex : notaire, avocat, organismes gouvernementaux, etc.) Nom du mandataire *Nom de l&#039;entreprise *T\u00e9l\u00e9phone * Fax Adresse courriel * Ajouter Retirer Frais 155&nbsp;$ + taxes \u2014 pour l&#8217;envoi et la pr\u00e9paration des documents. 125&nbsp;$ + taxes \u2014 pour l&#8217;ouverture de dossier pour : \u00c9glise Cimeti\u00e8re Columbarium Consentement \u00e0 la communication de renseignements \u00e0 un tiers Je, soussign\u00e9(e), autorise Services Fun\u00e9raires Azur Incin\u00e9ration Inc. \u00e0 transmettre les informations relatives au d\u00e9c\u00e8s du\/de la d\u00e9funt(e) nomm\u00e9(e) dans le formulaire \u00e0 des tiers (notaires, avocats, banques, organismes gouvernementaux, etc.) dans le cadre des d\u00e9marches administratives et successorales. * J&#8217;accepte la transmission des informations conform\u00e9ment \u00e0 ce consentement. En appuyant sur le bouton &quot;Soumettre&quot; J\u2019autorise Services fun\u00e9raire Azur incin\u00e9ration inc. \u00e0 transmettre et utiliser l\u2019ensemble des renseignements n\u00e9cessaires en conformit\u00e9 avec la Politique de protection des renseignements personnels et politique de confidentialit\u00e9. * D&#8217;accord Politique de protection des renseignements personnels et politique de confidentialit\u00e9 Attention! En appuyant sur le bouton soumettre ci-dessous, je d\u00e9clare avoir rempli consciencieusement le pr\u00e9sent questionnaire.Name Soumettre<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_templately_pack_id":"","_templately_imported_at":"","_templately_source":"","_templately_import_session_id":"","footnotes":""},"categories":[],"class_list":["post-1055","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Consent to the disclosure of personal information to a third party - Services fun\u00e9raires Azur incin\u00e9ration<\/title>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Consent to the disclosure of personal information to a third party - Services fun\u00e9raires Azur incin\u00e9ration\" \/>\n<meta property=\"og:description\" content=\"Consentement \u00e0 la communication de renseignements \u00e0 un tiersVeuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Directeur fun\u00e9raire : Denis Lachance Renseignements sur la personne d\u00e9c\u00e9d\u00e9e Nom de famille \u00e0 la naissance *Pr\u00e9nom *Autres pr\u00e9noms (S\u00e9parer chacun des pr\u00e9noms par une virgule)Sexe * Masculin F\u00e9minin Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Date du d\u00e9c\u00e8sJ12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 Renseignements sur le d\u00e9clarant du d\u00e9c\u00e8s Qualit\u00e9 du d\u00e9clarant (Personne responsable) * \u00c9poux ou conjoint d&#8217;union civile Proche parent Alli\u00e9 (parent par alliance) Autre Qualit\u00e9 du d\u00e9clarant, Pr\u00e9cision *Nom de famille \u00e0 la naissance du d\u00e9clarant *Pr\u00e9nom du d\u00e9clarant *T\u00e9l\u00e9phone au domicile *T\u00e9l\u00e9phone (Autre num\u00e9ro ex: mobile) *T\u00e9l\u00e9phone \u00e0 utiliser en priorit\u00e9 pour vous rejoindre *Courriel Indiquer les destinataires autoris\u00e9s (ex : notaire, avocat, organismes gouvernementaux, etc.) Nom du mandataire *Nom de l&#039;entreprise *T\u00e9l\u00e9phone * Fax Adresse courriel * Ajouter Retirer Frais 155&nbsp;$ + taxes \u2014 pour l&#8217;envoi et la pr\u00e9paration des documents. 125&nbsp;$ + taxes \u2014 pour l&#8217;ouverture de dossier pour : \u00c9glise Cimeti\u00e8re Columbarium Consentement \u00e0 la communication de renseignements \u00e0 un tiers Je, soussign\u00e9(e), autorise Services Fun\u00e9raires Azur Incin\u00e9ration Inc. \u00e0 transmettre les informations relatives au d\u00e9c\u00e8s du\/de la d\u00e9funt(e) nomm\u00e9(e) dans le formulaire \u00e0 des tiers (notaires, avocats, banques, organismes gouvernementaux, etc.) dans le cadre des d\u00e9marches administratives et successorales. * J&#8217;accepte la transmission des informations conform\u00e9ment \u00e0 ce consentement. 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En appuyant sur le bouton &quot;Soumettre&quot; J\u2019autorise Services fun\u00e9raire Azur incin\u00e9ration inc. \u00e0 transmettre et utiliser l\u2019ensemble des renseignements n\u00e9cessaires en conformit\u00e9 avec la Politique de protection des renseignements personnels et politique de confidentialit\u00e9. * D&#8217;accord Politique de protection des renseignements personnels et politique de confidentialit\u00e9 Attention! En appuyant sur le bouton soumettre ci-dessous, je d\u00e9clare avoir rempli consciencieusement le pr\u00e9sent questionnaire.Name Soumettre","og_url":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/","og_site_name":"Services fun\u00e9raires Azur incin\u00e9ration","article_modified_time":"2026-10-23T11:22:54+00:00","og_image":[{"url":"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/","url":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/","name":"Consent to the disclosure of personal information to a third party - Services fun\u00e9raires Azur incin\u00e9ration","isPartOf":{"@id":"https:\/\/azurdeces.com\/en\/#website"},"primaryImageOfPage":{"@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/#primaryimage"},"image":{"@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/#primaryimage"},"thumbnailUrl":"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg","datePublished":"2022-08-08T17:27:19+00:00","dateModified":"2026-10-23T11:22:54+00:00","breadcrumb":{"@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/#primaryimage","url":"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg","contentUrl":"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg"},{"@type":"BreadcrumbList","@id":"https:\/\/azurdeces.com\/en\/consent-to-the-disclosure-of-personal-information-to-a-third-party\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Accueil","item":"https:\/\/azurdeces.com\/en\/menu-en\/"},{"@type":"ListItem","position":2,"name":"Consent to the disclosure of personal information to a third party"}]},{"@type":"WebSite","@id":"https:\/\/azurdeces.com\/en\/#website","url":"https:\/\/azurdeces.com\/en\/","name":"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s","description":"Information Submission Form for a Death","publisher":{"@id":"https:\/\/azurdeces.com\/en\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/azurdeces.com\/en\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/azurdeces.com\/en\/#organization","name":"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s","url":"https:\/\/azurdeces.com\/en\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/azurdeces.com\/en\/#\/schema\/logo\/image\/","url":"https:\/\/azurdeces.com\/wp-content\/uploads\/2025\/04\/Service-Funeraire-Azur_2024_Couleur-siteicon.png","contentUrl":"https:\/\/azurdeces.com\/wp-content\/uploads\/2025\/04\/Service-Funeraire-Azur_2024_Couleur-siteicon.png","width":769,"height":769,"caption":"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s"},"image":{"@id":"https:\/\/azurdeces.com\/en\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages\/1055","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/comments?post=1055"}],"version-history":[{"count":0,"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages\/1055\/revisions"}],"wp:attachment":[{"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/media?parent=1055"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/categories?post=1055"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}