{"id":1082,"date":"2022-08-09T13:50:05","date_gmt":"2022-08-09T17:50:05","guid":{"rendered":"https:\/\/azurformulaire.com\/prearrangements\/"},"modified":"2026-10-23T07:23:42","modified_gmt":"2026-10-23T11:23:42","slug":"prearrangements","status":"publish","type":"page","link":"https:\/\/azurdeces.com\/en\/prearrangements\/","title":{"rendered":"Funeral arrangements without payment before death"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1082\" class=\"elementor elementor-1082 elementor-703\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b91dd63 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=\"b91dd63\" 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-aed630b 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=\"aed630b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-17e2ba2 elementor-widget elementor-widget-heading\" data-id=\"17e2ba2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Funeral arrangements without payment before death<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3c412a5 elementor-widget elementor-widget-html\" data-id=\"3c412a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel=\"stylesheet\" type=\"text\/css\" href=\"https:\/\/ws1.postescanada-canadapost.ca\/css\/addresscomplete-2.30.min.css?key=nh56-gu53-ap33-na91\"><script type=\"text\/javascript\" src=\"https:\/\/ws1.postescanada-canadapost.ca\/js\/addresscomplete-2.30.min.js?key=nh56-gu53-ap33-na91\"><\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f93740e elementor-widget elementor-widget-htwpform-addons\" data-id=\"f93740e\" 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 wpforms-mobile-full\" id=\"wpforms-7028\"><form id=\"wpforms-form-7028\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"7028\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/1082\" autocomplete=\"off\" data-token=\"87f65e66325eada8ac048ddea6ffd9f6\" data-token-time=\"1792861009\"><div class=\"wpforms-head-container\"><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#58a8de\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" data-page-1-title=\"Section 1: Information about the deceased\" data-page-2-title=\"Section 2: 2nd contact information\" data-page-3-title=\"Section 3: Information about the spouse (or ex-spouse) or civil union spouse (or ex-civil union spouse)\" data-page-4-title=\"Section 4: Declarant information\" data-page-5-title=\"Section 5: Other departments and agencies to be notified of death\" data-page-6-title=\"Section 6: Transport authorization\" data-page-7-title=\"Section 7: Other authorization requests\">Section 1: Information about the deceased<\/span><span class=\"wpforms-page-indicator-page-title-sep\" > - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of  7<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:14.285714285714%;background-color:#58a8de\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 wpforms-mobile-full\" data-page=\"1\"><div id=\"wpforms-7028-field_162-container\" class=\"wpforms-field wpforms-field-pagebreak wpforms-mobile-full\" data-field-type=\"pagebreak\" data-field-id=\"162\"><\/div><div id=\"wpforms-7028-field_51-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"51\"><div class=\"wpforms-field-description\">Collection of information for funeral arrangements without payment prior to death.\n<br\/>Funeral director: Denis Lachance.\n<br\/><br\/>IMPORTANT\n<br\/>-Read the general information and instructions that accompany this form.\n<br\/>-Fill in all sections of the form.\n<\/div><\/div><div id=\"wpforms-7028-field_215-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"215\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_215\">Creation Date<\/label><input type=\"text\" id=\"wpforms-7028-field_215\" class=\"wpforms-field-medium\" name=\"wpforms[fields][215]\" value=\"2026-10-24 12:56:49-0500\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_214-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"214\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_214\">Price<\/label><input type=\"text\" id=\"wpforms-7028-field_214\" class=\"wpforms-field-medium\" name=\"wpforms[fields][214]\" value=\"1000\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_190-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"190\"><label class=\"wpforms-field-label\">Are you filling out this funeral arrangement request for someone else or for yourself? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_190\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_190_1\" name=\"wpforms[fields][190]\" value=\"Myself\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_190_1\">Myself<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_190_2\" name=\"wpforms[fields][190]\" value=\"Someone else\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_190_2\">Someone else<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_202-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"202\" style=\"display:none;\"><label class=\"wpforms-field-label\">Priority contact <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_202\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_202_1\" name=\"wpforms[fields][202]\" value=\"Customer (yourself)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_202_1\">Customer (yourself)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_202_2\" name=\"wpforms[fields][202]\" value=\"2nd contact\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_202_2\">2nd contact<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_203-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"203\" style=\"display:none;\"><label class=\"wpforms-field-label\">Priority contact <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_203\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_203_1\" name=\"wpforms[fields][203]\" value=\"Customer\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_203_1\">Customer<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_203_2\" name=\"wpforms[fields][203]\" value=\"2nd contact (yourself)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_203_2\">2nd contact (yourself)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_23-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"23\"><h3 id=\"wpforms-7028-field_23\">Section 1: Customer information<\/h3><\/div><div id=\"wpforms-7028-field_0-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_0\">Family name at birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-7028-field_98-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_98\">First name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_98\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][98]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-7028-field_3-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full\" data-field-type=\"text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_3\">Other first names (Separate each first name with a comma)<\/label><input type=\"text\" id=\"wpforms-7028-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\" placeholder=\"Other first names\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_8-container\" class=\"wpforms-field wpforms-field-address wpforms-mobile-full\" data-field-type=\"address\" data-field-id=\"8\"><label class=\"wpforms-field-label\">Home address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7028-field_8\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][8][address1]\" required><label for=\"wpforms-7028-field_8\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_8-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][8][city]\" required><label for=\"wpforms-7028-field_8-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_8-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][8][state]\" value=\"Qu\u00e9bec\" required><label for=\"wpforms-7028-field_8-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_8-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][8][postal]\" required><label for=\"wpforms-7028-field_8-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-7028-field_8-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][8][country]\" value=\"CA\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-7028-field_8-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><div class=\"wpforms-field-description\"><p><strong>To avoid errors, please find your address using the Canada Post tool.<\/strong>  <img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/uploads\/2022\/02\/Logo_Postes_Canada.svg-1.png\" width=\"97\" height=\"23\" alt=\"Logo_Postes_Canada.svg-1.png\"><\/p><\/div><\/div><div id=\"wpforms-7028-field_211-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"211\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_211\">Home phone<\/label><input type=\"tel\" id=\"wpforms-7028-field_211\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][211]\" placeholder=\"(000) 000-0000\" aria-label=\"Home phone\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_212-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"212\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_212\">Cell phone<\/label><input type=\"tel\" id=\"wpforms-7028-field_212\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][212]\" placeholder=\"(000) 000-0000\" aria-label=\"Cell phone\" autocomplete=\"nope\" ><\/div>\t\t<div id=\"wpforms-7028-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-7028-field_1\" >union to other.<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-7028-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-7028-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-third wpforms-first wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_19_1\" name=\"wpforms[fields][19]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_19_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_19_2\" name=\"wpforms[fields][19]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_19_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_5-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-third wpforms-mobile-full\" data-field-type=\"date-time\" data-field-id=\"5\"><label class=\"wpforms-field-label\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][5][date][d]\" id=\"wpforms-7028-field_5-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][5][date][m]\" id=\"wpforms-7028-field_5-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][5][date][y]\" id=\"wpforms-7028-field_5-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-7028-field_173-container\" class=\"wpforms-field wpforms-field-select wpforms-one-third wpforms-mobile-full wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"173\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_173\">Estimated weight<\/label><select id=\"wpforms-7028-field_173\" class=\"wpforms-field-medium\" name=\"wpforms[fields][173]\"><option value=\"0 - 100 lbs\"  class=\"choice-4 depth-1\"  >0 - 100 lbs<\/option><option value=\"100 - 125 lbs\"  class=\"choice-5 depth-1\"  >100 - 125 lbs<\/option><option value=\"125 - 150 lbs\"  class=\"choice-6 depth-1\"  >125 - 150 lbs<\/option><option value=\"150 - 175 lbs\"  class=\"choice-7 depth-1\"  >150 - 175 lbs<\/option><option value=\"175 - 200 lbs\"  class=\"choice-8 depth-1\"  >175 - 200 lbs<\/option><option value=\"200 - 225 lbs\"  class=\"choice-9 depth-1\"  >200 - 225 lbs<\/option><option value=\"225 - 250 lbs\"  class=\"choice-10 depth-1\"  >225 - 250 lbs<\/option><option value=\"250 - 275 lbs\"  class=\"choice-11 depth-1\"  >250 - 275 lbs<\/option><option value=\"275 - 300 lbs\"  class=\"choice-12 depth-1\"  >275 - 300 lbs<\/option><option value=\"300 - 325 lbs\"  class=\"choice-13 depth-1\"  >300 - 325 lbs<\/option><option value=\"325 - 350 lbs\"  class=\"choice-14 depth-1\"  >325 - 350 lbs<\/option><option value=\"350 - 375 lbs\"  class=\"choice-15 depth-1\"  >350 - 375 lbs<\/option><option value=\"375 - 400 lbs\"  class=\"choice-16 depth-1\"  >375 - 400 lbs<\/option><option value=\"400 - 425 lbs\"  class=\"choice-17 depth-1\"  >400 - 425 lbs<\/option><option value=\"425 - 450 lbs\"  class=\"choice-18 depth-1\"  >425 - 450 lbs<\/option><option value=\"450 - 475 lbs\"  class=\"choice-19 depth-1\"  >450 - 475 lbs<\/option><\/select><\/div><div id=\"wpforms-7028-field_9-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_9\">Place of birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_9\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][9]\" placeholder=\"Village, municipality or town\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_10-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-mobile-full\" data-field-type=\"text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_10\">Place of birth registration <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" placeholder=\"Village, municipality or town\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_12-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_12\">Surname of parent at birth<\/label><input type=\"text\" id=\"wpforms-7028-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" placeholder=\"Last name\" ><\/div><div id=\"wpforms-7028-field_100-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_100\">Parent&#039;s first name<\/label><input type=\"text\" id=\"wpforms-7028-field_100\" class=\"wpforms-field-large\" name=\"wpforms[fields][100]\" placeholder=\"First name\" ><\/div><div id=\"wpforms-7028-field_17-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"17\"><label class=\"wpforms-field-label\">Parent&#039;s quality<\/label><ul id=\"wpforms-7028-field_17\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_17_1\" name=\"wpforms[fields][17]\" value=\"Father\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_17_1\">Father<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_17_2\" name=\"wpforms[fields][17]\" value=\"Mother\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_17_2\">Mother<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_14-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_14\">Last name of other parent at birth<\/label><input type=\"text\" id=\"wpforms-7028-field_14\" class=\"wpforms-field-large\" name=\"wpforms[fields][14]\" placeholder=\"Last name\" ><\/div><div id=\"wpforms-7028-field_101-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"101\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_101\">First name of other parent<\/label><input type=\"text\" id=\"wpforms-7028-field_101\" class=\"wpforms-field-medium\" name=\"wpforms[fields][101]\" placeholder=\"First name\" ><\/div><div id=\"wpforms-7028-field_16-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"16\"><label class=\"wpforms-field-label\">Quality of other parent<\/label><ul id=\"wpforms-7028-field_16\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_16_1\" name=\"wpforms[fields][16]\" value=\"Father\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_16_1\">Father<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_16_2\" name=\"wpforms[fields][16]\" value=\"Mother\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_16_2\">Mother<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_168-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-mobile-full wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"168\"><label class=\"wpforms-field-label\">Expected date of death<\/label><ul id=\"wpforms-7028-field_168\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7028-field_168_1\" name=\"wpforms[fields][168][]\" value=\"Date to come (check if you don&#039;t know the date)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_168_1\">Date to come (check if you don't know the date)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_106-container\" class=\"wpforms-field wpforms-field-date-time wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"date-time\" data-field-id=\"106\"><label class=\"wpforms-field-label wpforms-label-hide\">Expected date of death <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-7028-field_106\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][106][date]\" placeholder=\"Enter the expected date of death\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-7028-field_106\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-7028-field_106-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][106][time]\" required><label for=\"wpforms-7028-field_106-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/div><div id=\"wpforms-7028-field_170-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-mobile-full wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"170\"><label class=\"wpforms-field-label\">Place of death<\/label><ul id=\"wpforms-7028-field_170\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7028-field_170_1\" name=\"wpforms[fields][170][]\" value=\"Location unknown for the moment (check if you don&#039;t know the location)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_170_1\">Location unknown for the moment (check if you don't know the location)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_171-container\" class=\"wpforms-field wpforms-field-name wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"171\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_171\">  Name of hospital, name of CHSLD, at home, other. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_171\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][171]\" placeholder=\"Location\" required><\/div><div id=\"wpforms-7028-field_169-container\" class=\"wpforms-field wpforms-field-address wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"address\" data-field-id=\"169\"><label class=\"wpforms-field-label\">Estimated address of death <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7028-field_169\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][169][address1]\" required><label for=\"wpforms-7028-field_169\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_169-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][169][city]\" required><label for=\"wpforms-7028-field_169-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_169-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][169][state]\" value=\"Qu\u00e9bec\" required><label for=\"wpforms-7028-field_169-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_169-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][169][postal]\" required><label for=\"wpforms-7028-field_169-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-7028-field_169-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][169][country]\" value=\"CA\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-7028-field_169-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><div class=\"wpforms-field-description\"><p><strong>To avoid errors, please find your address using the Canada Post tool.<\/strong>  <img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/uploads\/2022\/02\/Logo_Postes_Canada.svg-1.png\" width=\"97\" height=\"23\" alt=\"Logo_Postes_Canada.svg-1.png\"><\/p><\/div><\/div><div id=\"wpforms-7028-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-2-columns wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"18\"><label class=\"wpforms-field-label\">Marital status at time of death <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_1\" name=\"wpforms[fields][18]\" value=\"Single\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_1\">Single<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_2\" name=\"wpforms[fields][18]\" value=\"Married\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_2\">Married<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_3\" name=\"wpforms[fields][18]\" value=\"Widower\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_3\">Widower<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_4\" name=\"wpforms[fields][18]\" value=\"Divorced\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_4\">Divorced<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_5\" name=\"wpforms[fields][18]\" value=\"Civil union\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_5\">Civil union<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_18_6\" name=\"wpforms[fields][18]\" value=\"Former civil union spouse\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_18_6\">Former civil union spouse<\/label><\/li><\/ul><div class=\"wpforms-field-description\"><a href=\"http:\/\/www.etatcivil.gouv.qc.ca\/fr\/mariage\/Types-unions.html\"> See the definition of union types on the Registrar of Civil Status's website<\/a><\/div><\/div><div id=\"wpforms-7028-field_205-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"205\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-7028-field_206-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"206\"><h3 id=\"wpforms-7028-field_206\">Section 2: 2nd contact information<\/h3><div class=\"wpforms-field-description\">In the event that Azur Funeral Services is unable to reach the customer, a 2nd contact person must be added to your file.  \nPlease fill in the 2nd contact information section.<\/div><\/div><div id=\"wpforms-7028-field_193-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"193\" style=\"display:none;\"><label class=\"wpforms-field-label\">What is your relationship with this person? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_193\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_1\" name=\"wpforms[fields][193]\" value=\"Spouse\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_1\">Spouse<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_2\" name=\"wpforms[fields][193]\" value=\"Brother\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_2\">Brother<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_3\" name=\"wpforms[fields][193]\" value=\"Sister\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_3\">Sister<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_6\" name=\"wpforms[fields][193]\" value=\"Father\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_6\">Father<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_5\" name=\"wpforms[fields][193]\" value=\"Mother\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_5\">Mother<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_4\" name=\"wpforms[fields][193]\" value=\"Friend\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_4\">Friend<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_193_7\" name=\"wpforms[fields][193]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_193_7\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_192-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"192\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_192\">Specify link. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_192\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][192]\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_209-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"209\"><label class=\"wpforms-field-label\">Name of 2nd contact <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_209\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][209][first]\" required><label for=\"wpforms-7028-field_209\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_209-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][209][last]\" required><label for=\"wpforms-7028-field_209-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><div class=\"wpforms-field-description\">Family name at birth<\/div><\/div><div id=\"wpforms-7028-field_210-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"210\"><label class=\"wpforms-field-label\">Address (2nd contact)<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7028-field_210\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][210][address1]\" ><label for=\"wpforms-7028-field_210\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_210-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][210][city]\" ><label for=\"wpforms-7028-field_210-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_210-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][210][state]\" value=\"Qu\u00e9bec\" ><label for=\"wpforms-7028-field_210-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_210-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][210][postal]\" ><label for=\"wpforms-7028-field_210-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-7028-field_210-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][210][country]\" value=\"CA\" ><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-7028-field_210-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-7028-field_221-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"221\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_221\">1st Phone (2nd contact)<\/label><input type=\"tel\" id=\"wpforms-7028-field_221\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][221]\" aria-label=\"1st Phone (2nd contact)\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_222-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"222\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_222\">2nd Phone (2nd contact)<\/label><input type=\"tel\" id=\"wpforms-7028-field_222\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][222]\" aria-label=\"2nd Phone (2nd contact)\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_219-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"219\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_219\">Telephone 4<\/label><input type=\"text\" id=\"wpforms-7028-field_219\" class=\"wpforms-field-medium\" name=\"wpforms[fields][219]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_220-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"220\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_220\">Telephone 5<\/label><input type=\"text\" id=\"wpforms-7028-field_220\" class=\"wpforms-field-medium\" name=\"wpforms[fields][220]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_213-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"213\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_213\">E-mail (2nd contact) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-7028-field_213\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][213]\" spellcheck=\"false\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_166-container\" class=\"wpforms-field wpforms-field-pagebreak wpforms-mobile-full\" data-field-type=\"pagebreak\" data-field-id=\"166\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"2\" data-formid=\"7028\" disabled>Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  wpforms-mobile-full\" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-7028-field_22-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"divider\" data-field-id=\"22\"><h3 id=\"wpforms-7028-field_22\">Section 3: Information about the spouse (or ex-spouse) or civil union spouse (or ex-civil union spouse)<\/h3><div class=\"wpforms-field-description\">Complete this section if you are married, in a civil union, widowed or divorced, or if your civil union has been dissolved.<\/div><\/div><div id=\"wpforms-7028-field_172-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"172\" style=\"display:none;\"><h3 id=\"wpforms-7028-field_172\">You have indicated that you are single. Go to section 3. <\/h3><div class=\"wpforms-field-description\">This section does not apply to you.\nPress Next to move on to the next section.<\/div><\/div><div id=\"wpforms-7028-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_29\">Family name at birth<\/label><input type=\"text\" id=\"wpforms-7028-field_29\" class=\"wpforms-field-large\" name=\"wpforms[fields][29]\" placeholder=\"Family name at birth\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_30-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_30\">First name<\/label><input type=\"text\" id=\"wpforms-7028-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" placeholder=\"First name\" autocomplete=\"nope\" ><div class=\"wpforms-field-description\">(Start with the usual first name, separated by a comma).<\/div><\/div><div id=\"wpforms-7028-field_31-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"31\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-7028-field_31\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_31_1\" name=\"wpforms[fields][31]\" value=\"Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_31_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_31_2\" name=\"wpforms[fields][31]\" value=\"Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_31_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_32-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"date-time\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Date of birth<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][32][date][d]\" id=\"wpforms-7028-field_32-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][32][date][m]\" id=\"wpforms-7028-field_32-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][32][date][y]\" id=\"wpforms-7028-field_32-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-7028-field_33-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_33\">Place of birth<\/label><input type=\"text\" id=\"wpforms-7028-field_33\" class=\"wpforms-field-large\" name=\"wpforms[fields][33]\" placeholder=\"Place of birth\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_34-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_34\">Place of birth registration<\/label><input type=\"text\" id=\"wpforms-7028-field_34\" class=\"wpforms-field-large\" name=\"wpforms[fields][34]\" placeholder=\"Place of birth registration\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_25-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_25\">Place of registration of marriage or civil union<\/label><input type=\"text\" id=\"wpforms-7028-field_25\" class=\"wpforms-field-large\" name=\"wpforms[fields][25]\" placeholder=\"Place of registration\" autocomplete=\"nope\" ><div class=\"wpforms-field-description\">(place of worship, parish, town, village or municipality, province or country).<\/div><\/div><div id=\"wpforms-7028-field_24-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"date-time\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Date of marriage or civil union<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][24][date][d]\" id=\"wpforms-7028-field_24-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][24][date][m]\" id=\"wpforms-7028-field_24-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][24][date][y]\" id=\"wpforms-7028-field_24-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-7028-field_26-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"date-time\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Date of death, divorce or dissolution of civil union<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][26][date][d]\" id=\"wpforms-7028-field_26-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][26][date][m]\" id=\"wpforms-7028-field_26-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][26][date][y]\" id=\"wpforms-7028-field_26-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-7028-field_198-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"layout\" data-field-id=\"198\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-7028-field_199-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"199\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_199\">City at time of divorce<\/label><input type=\"text\" id=\"wpforms-7028-field_199\" class=\"wpforms-field-medium\" name=\"wpforms[fields][199]\" autocomplete=\"nope\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-7028-field_201-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"text\" data-field-id=\"201\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_201\">Province at time of divorce<\/label><input type=\"text\" id=\"wpforms-7028-field_201\" class=\"wpforms-field-medium\" name=\"wpforms[fields][201]\" autocomplete=\"nope\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-7028-field_35-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_35\">Surname at birth (parent)<\/label><input type=\"text\" id=\"wpforms-7028-field_35\" class=\"wpforms-field-large\" name=\"wpforms[fields][35]\" placeholder=\"Family name at birth\" ><\/div><div id=\"wpforms-7028-field_102-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"102\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_102\">First name (parent)<\/label><input type=\"text\" id=\"wpforms-7028-field_102\" class=\"wpforms-field-large\" name=\"wpforms[fields][102]\" placeholder=\"First name\" ><\/div><div id=\"wpforms-7028-field_36-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"36\"><label class=\"wpforms-field-label\">Parent&#039;s quality<\/label><ul id=\"wpforms-7028-field_36\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_36_1\" name=\"wpforms[fields][36]\" value=\"Father\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_36_1\">Father<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_36_2\" name=\"wpforms[fields][36]\" value=\"Mother\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_36_2\">Mother<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_37-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_37\">Last name at birth (other parent)<\/label><input type=\"text\" id=\"wpforms-7028-field_37\" class=\"wpforms-field-large\" name=\"wpforms[fields][37]\" placeholder=\"Family name at birth\" ><\/div><div id=\"wpforms-7028-field_103-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"name\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_103\">First name (other parent)<\/label><input type=\"text\" id=\"wpforms-7028-field_103\" class=\"wpforms-field-large\" name=\"wpforms[fields][103]\" placeholder=\"First name\" ><\/div><div id=\"wpforms-7028-field_38-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"radio\" data-field-id=\"38\"><label class=\"wpforms-field-label\">Quality of other parent<\/label><ul id=\"wpforms-7028-field_38\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_38_1\" name=\"wpforms[fields][38]\" value=\"Father\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_38_1\">Father<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_38_2\" name=\"wpforms[fields][38]\" value=\"Mother\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_38_2\">Mother<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_167-container\" class=\"wpforms-field wpforms-field-pagebreak wpforms-mobile-full\" data-field-type=\"pagebreak\" data-field-id=\"167\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"3\" data-formid=\"7028\" disabled>Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  wpforms-mobile-full\" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-7028-field_42-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"42\"><h3 id=\"wpforms-7028-field_42\">Section 4: Declarant information<\/h3><\/div><div id=\"wpforms-7028-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"43\"><label class=\"wpforms-field-label\">Quality of declarant (Responsible for file) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_43_1\" name=\"wpforms[fields][43]\" value=\"Civil union spouse\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_43_1\">Civil union spouse<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_43_2\" name=\"wpforms[fields][43]\" value=\"Close relative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_43_2\">Close relative<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_43_3\" name=\"wpforms[fields][43]\" value=\"Ally (relative by marriage)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_43_3\">Ally (relative by marriage)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_43_4\" name=\"wpforms[fields][43]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_43_4\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_45-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full 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-7028-field_45\">Quality of declarant, Precision <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_45\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][45]\" placeholder=\"Precision\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_46-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_46\">Surname at birth (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_46\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-7028-field_99-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full\" data-field-type=\"name\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_99\">First name (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_99\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][99]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-7028-field_47-container\" class=\"wpforms-field wpforms-field-address wpforms-mobile-full\" data-field-type=\"address\" data-field-id=\"47\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-7028-field_47\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][47][address1]\" required><label for=\"wpforms-7028-field_47\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_47-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][47][city]\" required><label for=\"wpforms-7028-field_47-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7028-field_47-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][47][state]\" value=\"Qu\u00e9bec\" required><label for=\"wpforms-7028-field_47-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-7028-field_47-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][47][postal]\" required><label for=\"wpforms-7028-field_47-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-7028-field_47-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][47][country]\" value=\"CA\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-7028-field_47-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><div class=\"wpforms-field-description\"><p><strong>To avoid errors, please find your address using the Canada Post tool.<\/strong>  <img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/uploads\/2022\/02\/Logo_Postes_Canada.svg-1.png\" width=\"97\" height=\"23\" alt=\"Logo_Postes_Canada.svg-1.png\"><\/p><\/div><\/div><div id=\"wpforms-7028-field_216-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"phone\" data-field-id=\"216\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_216\">Home telephone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-7028-field_216\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][216]\" placeholder=\"(999) 999-9999\" aria-label=\"Home telephone\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_217-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"phone\" data-field-id=\"217\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_217\">Cell phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-7028-field_217\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][217]\" placeholder=\"(999) 999-9999\" aria-label=\"Cell phone\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_218-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-mobile-full\" data-field-type=\"phone\" data-field-id=\"218\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_218\">Phone number to use to reach you <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-7028-field_218\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][218]\" placeholder=\"(999) 999-9999\" aria-label=\"Phone number to use to reach you\" autocomplete=\"nope\" required><\/div><div id=\"wpforms-7028-field_49-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_49\">Home telephone<\/label><input type=\"text\" id=\"wpforms-7028-field_49\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][49]\" placeholder=\"(000) 000-0000\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_97-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"97\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_97\">Cell phone<\/label><input type=\"text\" id=\"wpforms-7028-field_97\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][97]\" placeholder=\"(000) 000-0000\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_156-container\" class=\"wpforms-field wpforms-field-text wpforms-hidden\" data-field-type=\"text\" data-field-id=\"156\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_156\">Phone number to use to reach you<\/label><input type=\"text\" id=\"wpforms-7028-field_156\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][156]\" placeholder=\"(000) 000-0000\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_96-container\" class=\"wpforms-field wpforms-field-email wpforms-mobile-full\" data-field-type=\"email\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_96\">Declarer&#039;s e-mail address (Responsible for file)<\/label><input type=\"email\" id=\"wpforms-7028-field_96\" class=\"wpforms-field-large\" name=\"wpforms[fields][96]\" placeholder=\"E-mail\" spellcheck=\"false\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_165-container\" class=\"wpforms-field wpforms-field-pagebreak wpforms-mobile-full\" data-field-type=\"pagebreak\" data-field-id=\"165\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"4\" data-formid=\"7028\" disabled>Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  wpforms-mobile-full\" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-7028-field_105-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"105\"><h3 id=\"wpforms-7028-field_105\">Section 5: Other departments and agencies to be notified of death<\/h3><div class=\"wpforms-field-description\">Answer the questions below and enter the requested information, if applicable.<\/div><\/div><div id=\"wpforms-7028-field_111-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"111\"><div id=\"wpforms-7028-field_111\"><h4>Retraite Qu\u00e9bec - Public sector pension plans (RREGOP, RRPE or other).<\/h4><\/div><\/div><div id=\"wpforms-7028-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"112\"><label class=\"wpforms-field-label\">To the best of your knowledge, was the deceased receiving benefits from, or a member of, a public-sector pension plan?  <\/label><ul id=\"wpforms-7028-field_112\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_112_1\" name=\"wpforms[fields][112]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_112_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_112_2\" name=\"wpforms[fields][112]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_112_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_113-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"113\"><div id=\"wpforms-7028-field_113\"><h4>Public Curator of Qu\u00e9bec<\/h4><\/div><\/div><div id=\"wpforms-7028-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"114\"><label class=\"wpforms-field-label\">To the best of your knowledge, was the deceased under protective supervision? If yes, indicate the situation that applied to the deceased. <\/label><ul id=\"wpforms-7028-field_114\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_114_1\" name=\"wpforms[fields][114]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_114_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_114_2\" name=\"wpforms[fields][114]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_114_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_115-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"115\" style=\"display:none;\"><label class=\"wpforms-field-label\">Multiple choice<\/label><ul id=\"wpforms-7028-field_115\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_115_1\" name=\"wpforms[fields][115]\" value=\"She was represented by a mandatary (court-approved mandate in anticipation of incapacity).\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_115_1\">She was represented by a mandatary (court-approved mandate in anticipation of incapacity).<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_115_2\" name=\"wpforms[fields][115]\" value=\"She was under tutorship or public curatorship (assumed by the Curateur public du Qu\u00e9bec).\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_115_2\">She was under tutorship or public curatorship (assumed by the Curateur public du Qu\u00e9bec).<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_115_3\" name=\"wpforms[fields][115]\" value=\"She was under guardianship or private curatorship.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_115_3\">She was under guardianship or private curatorship.<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"116\"><label class=\"wpforms-field-label\">To your knowledge, was the deceased the legal representative of an incompetent person?<\/label><ul id=\"wpforms-7028-field_116\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_116_1\" name=\"wpforms[fields][116]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_116_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_116_2\" name=\"wpforms[fields][116]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_116_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"117\" style=\"display:none;\"><label class=\"wpforms-field-label\">Multiple choice<\/label><ul id=\"wpforms-7028-field_117\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_117_1\" name=\"wpforms[fields][117]\" value=\"Mandataire (court-approved mandate in anticipation of incapacity)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_117_1\">Mandataire (court-approved mandate in anticipation of incapacity)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_117_2\" name=\"wpforms[fields][117]\" value=\"Private tutor or curator\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_117_2\">Private tutor or curator<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_118-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_118\">Last name of person represented (if known): <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_118\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][118]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-7028-field_119-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"119\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_119\">First name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-7028-field_119\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][119]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-7028-field_122-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"122\"><div id=\"wpforms-7028-field_122\"><h4>Minist\u00e8re du travail, de l'Emploi et de la Solidarit\u00e9 sociale - Quebec Parental Insurance Plan<\/h4><\/div><\/div><div id=\"wpforms-7028-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"123\"><label class=\"wpforms-field-label\">To the best of your knowledge, had the deceased filed a claim for Quebec Parental Insurance Plan benefits, or was he or she receiving such benefits because of an upcoming or recent birth or adoption?<\/label><ul id=\"wpforms-7028-field_123\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_123_1\" name=\"wpforms[fields][123]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_123_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_123_2\" name=\"wpforms[fields][123]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_123_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_124-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"124\"><div id=\"wpforms-7028-field_124\"><h4>R\u00e9gie du b\u00e2timent du Qu\u00e9bec<\/h4><\/div><\/div><div id=\"wpforms-7028-field_125-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"125\"><label class=\"wpforms-field-label\">To the best of your knowledge, was the deceased a building contractor, guarantor or builder-owner licensed by the R\u00e9gie du b\u00e2timent du Qu\u00e9bec?<\/label><ul id=\"wpforms-7028-field_125\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_125_1\" name=\"wpforms[fields][125]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_125_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_125_2\" name=\"wpforms[fields][125]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_125_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_126-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"126\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_126\">If you answered Yes, enter the license number.<\/label><input type=\"text\" id=\"wpforms-7028-field_126\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"****-****-**\" name=\"wpforms[fields][126]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_127-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"127\"><div id=\"wpforms-7028-field_127\"><h4>Aboriginal Affairs and Northern Development Canada<\/h4><\/div><\/div><div id=\"wpforms-7028-field_128-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"128\"><label class=\"wpforms-field-label\">To your knowledge, had the deceased been granted Indian status under the Indian Act by the federal government?<\/label><ul id=\"wpforms-7028-field_128\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_128_1\" name=\"wpforms[fields][128]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_128_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_128_2\" name=\"wpforms[fields][128]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_128_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_129-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"129\" style=\"display:none;\"><div id=\"wpforms-7028-field_129\"><h4>If you answered Yes, please enter the information requested below.<\/h4><\/div><\/div><div id=\"wpforms-7028-field_130-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"130\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_130\">Band number<\/label><input type=\"text\" id=\"wpforms-7028-field_130\" class=\"wpforms-field-small wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"***\" name=\"wpforms[fields][130]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_131-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"131\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_131\">Band name<\/label><input type=\"text\" id=\"wpforms-7028-field_131\" class=\"wpforms-field-medium\" name=\"wpforms[fields][131]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_132-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"132\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_132\">Indian registration number<\/label><input type=\"text\" id=\"wpforms-7028-field_132\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"**********\" name=\"wpforms[fields][132]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_136-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"136\"><div id=\"wpforms-7028-field_136\"><h4>Minist\u00e8re de la Sant\u00e9 et des Services sociaux - Direction des affaires autochtones II<\/h4><\/div><\/div><div id=\"wpforms-7028-field_137-container\" class=\"wpforms-field wpforms-field-radio wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"137\"><label class=\"wpforms-field-label\">To your knowledge, had the deceased been recognized as a Cree or Naskapi beneficiary under the Cree-Inuit-Naskapi Native Act by the Government of Quebec?<\/label><ul id=\"wpforms-7028-field_137\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_137_1\" name=\"wpforms[fields][137]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_137_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_137_2\" name=\"wpforms[fields][137]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_137_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_138-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"138\"><div id=\"wpforms-7028-field_138\"><h4>If you answered Yes, please enter the information requested below.<\/h4><\/div><\/div><div id=\"wpforms-7028-field_139-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"139\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_139\">Affiliate community name<\/label><input type=\"text\" id=\"wpforms-7028-field_139\" class=\"wpforms-field-medium\" name=\"wpforms[fields][139]\" placeholder=\"Affiliate community name\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_140-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"140\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_140\">Cree or Naskapi beneficiary number<\/label><input type=\"text\" id=\"wpforms-7028-field_140\" class=\"wpforms-field-medium\" name=\"wpforms[fields][140]\" placeholder=\"Cree or Naskapi beneficiary number\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_141-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"141\"><div id=\"wpforms-7028-field_141\"><\/div><\/div><div id=\"wpforms-7028-field_142-container\" class=\"wpforms-field wpforms-field-radio wpforms-two-thirds wpforms-first wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"142\"><label class=\"wpforms-field-label\">To your knowledge, did the deceased hold a firearms licence?<\/label><ul id=\"wpforms-7028-field_142\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_142_1\" name=\"wpforms[fields][142]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_142_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_142_2\" name=\"wpforms[fields][142]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_142_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_143-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"143\" style=\"display:none;\"><div id=\"wpforms-7028-field_143\"><h4>If you answered Yes, enter the first eight digits of your firearms licence number below, if known.<\/h4><\/div><\/div><div id=\"wpforms-7028-field_144-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"144\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_144\">Firearms licence number<\/label><input type=\"text\" id=\"wpforms-7028-field_144\" class=\"wpforms-field-medium\" name=\"wpforms[fields][144]\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_145-container\" class=\"wpforms-field wpforms-field-radio wpforms-two-thirds wpforms-first wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"145\"><label class=\"wpforms-field-label\">To your knowledge, did the deceased own one or more firearms?<\/label><ul id=\"wpforms-7028-field_145\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_145_1\" name=\"wpforms[fields][145]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_145_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_145_2\" name=\"wpforms[fields][145]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_145_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_146-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"146\"><div id=\"wpforms-7028-field_146\"><h4>Minist\u00e8re de la S\u00e9curit\u00e9 publique - Quebec Firearms Registration Service<\/h4><\/div><\/div><div id=\"wpforms-7028-field_147-container\" class=\"wpforms-field wpforms-field-radio wpforms-two-thirds wpforms-first wpforms-mobile-full wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"147\"><label class=\"wpforms-field-label\">To your knowledge, did the deceased own one or more non-restricted firearms registered in the Fichier d&#039;immatriculation des armes \u00e0 feu du Qu\u00e9bec?<\/label><ul id=\"wpforms-7028-field_147\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_147_1\" name=\"wpforms[fields][147]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_147_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_147_2\" name=\"wpforms[fields][147]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_147_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_148-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"148\"><div id=\"wpforms-7028-field_148\"><h4>Soci\u00e9t\u00e9 de l'assurance automobile du Qu\u00e9bec<\/h4><\/div><\/div><div id=\"wpforms-7028-field_149-container\" class=\"wpforms-field wpforms-field-radio wpforms-two-thirds wpforms-first wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"149\"><label class=\"wpforms-field-label\">To your knowledge, did the deceased hold a driver&#039;s licence issued by the Soci\u00e9t\u00e9 de l&#039;assurance automobile du Qu\u00e9bec?<\/label><ul id=\"wpforms-7028-field_149\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_149_1\" name=\"wpforms[fields][149]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_149_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_149_2\" name=\"wpforms[fields][149]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_149_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_150-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"150\" style=\"display:none;\"><div id=\"wpforms-7028-field_150\"><h4>If you answered Yes, please enter your driver's license number below.  <\/h4><\/div><\/div><div id=\"wpforms-7028-field_151-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"151\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_151\">Driver&#039;s license number<\/label><input type=\"text\" id=\"wpforms-7028-field_151\" class=\"wpforms-field-medium\" name=\"wpforms[fields][151]\" placeholder=\"Permit number\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_152-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full\" data-field-type=\"html\" data-field-id=\"152\"><div id=\"wpforms-7028-field_152\"><h4>Commission des normes, de l'\u00e9quit\u00e9, de la sant\u00e9 et de la s\u00e9curit\u00e9 du travail<\/h4><\/div><\/div><div id=\"wpforms-7028-field_153-container\" class=\"wpforms-field wpforms-field-radio wpforms-two-thirds wpforms-first wpforms-mobile-full wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"153\"><label class=\"wpforms-field-label\">To the best of your knowledge, was the deceased receiving any benefits from the Commission des normes, de l&#039;\u00e9quit\u00e9, de la sant\u00e9 et de la s\u00e9curit\u00e9 du travail (income replacement benefits, death benefits, drug reimbursement, payment for a hearing aid, home personal assistance allowance, care or treatment, etc.)?<\/label><ul id=\"wpforms-7028-field_153\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_153_1\" name=\"wpforms[fields][153]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_153_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_153_2\" name=\"wpforms[fields][153]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_153_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_154-container\" class=\"wpforms-field wpforms-field-html wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"html\" data-field-id=\"154\" style=\"display:none;\"><div id=\"wpforms-7028-field_154\"><h4>  If you answered Yes, enter the deceased's file number below, if known.<\/h4><\/div><\/div><div id=\"wpforms-7028-field_155-container\" class=\"wpforms-field wpforms-field-text wpforms-mobile-full wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"155\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_155\">File number<\/label><input type=\"text\" id=\"wpforms-7028-field_155\" class=\"wpforms-field-medium\" name=\"wpforms[fields][155]\" placeholder=\"File number\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_161-container\" class=\"wpforms-field wpforms-field-pagebreak wpforms-mobile-full\" data-field-type=\"pagebreak\" data-field-id=\"161\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"5\" data-formid=\"7028\" disabled>Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"5\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  wpforms-mobile-full\" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-7028-field_175-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"175\"><h3 id=\"wpforms-7028-field_175\">Section 6: Cremation request<\/h3><\/div><div id=\"wpforms-7028-field_183-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"183\"><label class=\"wpforms-field-label\">Did the deceased leave any instructions regarding the mode of disposition? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_183\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_183_1\" name=\"wpforms[fields][183]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_183_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_183_2\" name=\"wpforms[fields][183]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_183_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_184-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"184\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7028-field_184\">Layout, precision<\/label><input type=\"text\" id=\"wpforms-7028-field_184\" class=\"wpforms-field-medium\" name=\"wpforms[fields][184]\" placeholder=\"If so, please specify:\" autocomplete=\"nope\" ><\/div><div id=\"wpforms-7028-field_185-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"185\"><label class=\"wpforms-field-label\">Do you have any objections to cremation of the deceased? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_185\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_185_1\" name=\"wpforms[fields][185]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_185_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_185_2\" name=\"wpforms[fields][185]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_185_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_186-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"186\"><label class=\"wpforms-field-label\">Does the deceased have a pacemaker? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_186\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_186_1\" name=\"wpforms[fields][186]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_186_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_186_2\" name=\"wpforms[fields][186]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_186_2\">No<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_186_4\" name=\"wpforms[fields][186]\" value=\"Don&#039;t know\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_186_4\">Don't know<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_187-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"187\"><label class=\"wpforms-field-label\" for=\"wpforms-7028-field_187\">Add any information you consider relevant here.<\/label><textarea id=\"wpforms-7028-field_187\" class=\"wpforms-field-medium\" name=\"wpforms[fields][187]\" ><\/textarea><\/div><div id=\"wpforms-7028-field_188-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"188\"><h3 id=\"wpforms-7028-field_188\">Authorization for cremation<\/h3><\/div><div id=\"wpforms-7028-field_189-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"189\"><label class=\"wpforms-field-label\">I authorize Cr\u00e9matorium des Deux Rives Inc. to proceed with the cremation.  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_189\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_189_1\" name=\"wpforms[fields][189]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_189_1\">I agree.<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_176-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"176\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"6\" data-formid=\"7028\" disabled>Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"6\" data-formid=\"7028\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7 last \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-7028-field_164-container\" class=\"wpforms-field wpforms-field-divider wpforms-mobile-full\" data-field-type=\"divider\" data-field-id=\"164\"><h3 id=\"wpforms-7028-field_164\">Section 7: Other authorization requests<\/h3><\/div><div id=\"wpforms-7028-field_177-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"177\"><h3 id=\"wpforms-7028-field_177\">Personal effects<\/h3><\/div><div id=\"wpforms-7028-field_181-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-mobile-full\" data-field-type=\"checkbox\" data-field-id=\"181\"><label class=\"wpforms-field-label\">Due to the current situation surrounding the coronavirus, it is now your responsibility to recover the deceased&#039;s personal belongings at the place of death (e.g. hospital, Chsld, etc.). <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_181\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7028-field_181_1\" name=\"wpforms[fields][181][]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_181_1\">I agree.<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_178-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"178\"><h3 id=\"wpforms-7028-field_178\">Transport<\/h3><\/div><div id=\"wpforms-7028-field_160-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-mobile-full\" data-field-type=\"checkbox\" data-field-id=\"160\"><label class=\"wpforms-field-label\">By pressing the &quot;Submit&quot; button, I authorize Services Fun\u00e9raires Azur Incin\u00e9ration Inc. to transport the above-mentioned deceased.  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_160\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-7028-field_160_1\" name=\"wpforms[fields][160][]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_160_1\">I agree.<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_197-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"197\"><h3 id=\"wpforms-7028-field_197\">Consent to publication of death notice<\/h3><\/div><div id=\"wpforms-7028-field_195-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"195\"><label class=\"wpforms-field-label\">By submitting this form, I agree to have my obituary published on the Service Fun\u00e9raire Azur website. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-7028-field_195\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_195_1\" name=\"wpforms[fields][195]\" value=\"Yes, I accept the publication\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_195_1\">Yes, I accept the publication<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7028-field_195_2\" name=\"wpforms[fields][195]\" value=\"No, I refuse publication\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_195_2\">No, I refuse publication<\/label><\/li><\/ul><\/div><div id=\"wpforms-7028-field_179-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"179\"><h3 id=\"wpforms-7028-field_179\">Protection of personal information<\/h3><\/div><div id=\"wpforms-7028-field_174-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-type=\"gdpr-checkbox\" data-field-id=\"174\"><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-7028-field_174\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-7028-field_174_1\" name=\"wpforms[fields][174][]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7028-field_174_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-7028-field_163-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"163\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"7\" data-formid=\"7028\" disabled>Previous<\/button><\/span><\/div><\/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-7028-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-7028-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-7028-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\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"7028\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792861009.587cd6b2d462d879db0c211664977f32d9a5f8eed2b9b941f2a5ffcb3d15c45d\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages\/1082\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-7028\" class=\"wpforms-submit wpforms-mobile-full\" data-alt-text=\"In progress...\" data-submit-text=\"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>Funeral arrangements without payment before death Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Section 1: Renseignements sur la personne d\u00e9c\u00e9d\u00e9e &#8211; \u00c9tape 1 de 7Cueillette d&#8217;informations pour des arrangements fun\u00e9raires sans paiement avant le d\u00e9c\u00e8s. Directeur fun\u00e9raire : Denis Lachance. IMPORTANT -Lisez les renseignements g\u00e9n\u00e9raux et les directives qui accompagnent ce formulaire. -Remplissez toutes les sections du formulaire. Date_creationPrixRemplissez-vous cette demande d&#039;arrangement fun\u00e9raire pour quelqu&#039;un d&#039;autre ou pour vous-m\u00eame? * Moi-m\u00eame Quelqu&#8217;un d&#8217;autre Personne \u00e0 contacter en priorit\u00e9 * Client (vous-m\u00eame) 2i\u00e8me contact Personne \u00e0 contacter en priorit\u00e9 * Client 2i\u00e8me contact (vous-m\u00eame) Section 1: Renseignements sur le client Nom de famille \u00e0 la naissance *Pr\u00e9nom *Autres pr\u00e9noms (S\u00e9parer chacun des pr\u00e9noms par une virgule)Adresse du domicile *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 T\u00e9l\u00e9phone domicileT\u00e9l\u00e9phone mobileSexe * Masculin F\u00e9minin Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Poids estim\u00e90 &#8211; 100 lbs100 &#8211; 125 lbs125 &#8211; 150 lbs150 &#8211; 175 lbs175 &#8211; 200 lbs200 &#8211; 225 lbs225 &#8211; 250 lbs250 &#8211; 275 lbs275 &#8211; 300 lbs300 &#8211; 325 lbs325 &#8211; 350 lbs350 &#8211; 375 lbs375 &#8211; 400 lbs400 &#8211; 425 lbs425 &#8211; 450 lbs450 &#8211; 475 lbsLieu de naissance *Lieu de l&#039;inscription de la naissance *Nom de famille du parent \u00e0 la naissancePr\u00e9nom du parentQualit\u00e9 du parent P\u00e8re M\u00e8re Nom de famille l&#039;autre parent \u00e0 la naissancePr\u00e9nom de l&#039;autre parentQualit\u00e9 de l&#039;autre parent P\u00e8re M\u00e8re Date pr\u00e9vue du d\u00e9c\u00e8s Date \u00e0 venir (cocher si vous ne connaissez pas la date) Date pr\u00e9vue du d\u00e9c\u00e8s *DateHeureLieu pr\u00e9vu du d\u00e9c\u00e8s Lieu inconnu pour le moment (cocher si vous ne connaissez pas le lieu) Nom du centre hospitalier, nom du CHSLD, \u00e0 domicile, autre. *Adresse pr\u00e9vu du d\u00e9c\u00e8s *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 \u00c9tat matrimonial au moment du d\u00e9c\u00e8s * C\u00e9libataire Mari\u00e9 Veuf Divorc\u00e9 Uni civilement Ex-conjoint d&#8217;union civile Voir la d\u00e9finition des types d&#8217;unions sur le site du Directeur de l&#8217;\u00e9tat civilSuivant Section 2: Renseignements sur le 2i\u00e8me contact Dans l&#8217;\u00e9ventualit\u00e9 ou services fun\u00e9raires Azur serait incapable de joindre le client, une 2i\u00e8me personne \u00e0 contacter doit \u00eatre ajout\u00e9 \u00e0 votre dossier. Merci de remplir la section, Renseignement sur le 2i\u00e8me contact.Quelques est votre lien par rapport \u00e0 cette personne? * Conjoint(e) Fr\u00e8re Soeur P\u00e8re M\u00e8re Ami Autre Pr\u00e9cisez le lien. *Nom du 2i\u00e8me contact *Pr\u00e9nomNomNom de famille \u00e0 la naissanceAdresse (2i\u00e8me contact)Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays1er T\u00e9l\u00e9phone (2i\u00e8me contact)2e T\u00e9l\u00e9phone (2i\u00e8me contact)Telephone 4Telephone 5Courriel (2i\u00e8me contact) *Pr\u00e9c\u00e9dentSuivant Section 3: Renseignements sur l&#039;\u00e9poux (ou l&#039;ex-\u00e9poux) ou le conjoint d&#039;union civile (ou l&#039;ex-conjoint d&#039;union civile) Remplissez cette section si la personne est mari\u00e9e, unie civilement, veuve ou divorc\u00e9e ou que son union civile \u00e9tait dissoute. Vous avez indiqu\u00e9 \u00eatre c\u00e9libataire. Passez \u00e0 la section 3. Cette section ne s&#8217;applique pas \u00e0 vous. Appuyez sur suivant pour passer \u00e0 la prochaine section.Nom de famille \u00e0 la naissancePr\u00e9nom(Commencer par le pr\u00e9nom usuel. S\u00e9parez chacun des pr\u00e9noms par une virgule.)Sexe Masculin F\u00e9minin Date de naissanceJ12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissanceLieu de l&#039;inscription de la naissanceLieu de l&#039;inscription du mariage ou de l&#039;union civile(lieu de culte, paroisse, ville, village ou municipalit\u00e9, province ou<\/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-1082","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>Funeral arrangements without payment before death - 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=\"Funeral arrangements without payment before death - Services fun\u00e9raires Azur incin\u00e9ration\" \/>\n<meta property=\"og:description\" content=\"Funeral arrangements without payment before death Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Section 1: Renseignements sur la personne d\u00e9c\u00e9d\u00e9e &#8211; \u00c9tape 1 de 7Cueillette d&#8217;informations pour des arrangements fun\u00e9raires sans paiement avant le d\u00e9c\u00e8s. Directeur fun\u00e9raire : Denis Lachance. IMPORTANT -Lisez les renseignements g\u00e9n\u00e9raux et les directives qui accompagnent ce formulaire. -Remplissez toutes les sections du formulaire. Date_creationPrixRemplissez-vous cette demande d&#039;arrangement fun\u00e9raire pour quelqu&#039;un d&#039;autre ou pour vous-m\u00eame? * Moi-m\u00eame Quelqu&#8217;un d&#8217;autre Personne \u00e0 contacter en priorit\u00e9 * Client (vous-m\u00eame) 2i\u00e8me contact Personne \u00e0 contacter en priorit\u00e9 * Client 2i\u00e8me contact (vous-m\u00eame) Section 1: Renseignements sur le client Nom de famille \u00e0 la naissance *Pr\u00e9nom *Autres pr\u00e9noms (S\u00e9parer chacun des pr\u00e9noms par une virgule)Adresse du domicile *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 T\u00e9l\u00e9phone domicileT\u00e9l\u00e9phone mobileSexe * Masculin F\u00e9minin Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Poids estim\u00e90 &#8211; 100 lbs100 &#8211; 125 lbs125 &#8211; 150 lbs150 &#8211; 175 lbs175 &#8211; 200 lbs200 &#8211; 225 lbs225 &#8211; 250 lbs250 &#8211; 275 lbs275 &#8211; 300 lbs300 &#8211; 325 lbs325 &#8211; 350 lbs350 &#8211; 375 lbs375 &#8211; 400 lbs400 &#8211; 425 lbs425 &#8211; 450 lbs450 &#8211; 475 lbsLieu de naissance *Lieu de l&#039;inscription de la naissance *Nom de famille du parent \u00e0 la naissancePr\u00e9nom du parentQualit\u00e9 du parent P\u00e8re M\u00e8re Nom de famille l&#039;autre parent \u00e0 la naissancePr\u00e9nom de l&#039;autre parentQualit\u00e9 de l&#039;autre parent P\u00e8re M\u00e8re Date pr\u00e9vue du d\u00e9c\u00e8s Date \u00e0 venir (cocher si vous ne connaissez pas la date) Date pr\u00e9vue du d\u00e9c\u00e8s *DateHeureLieu pr\u00e9vu du d\u00e9c\u00e8s Lieu inconnu pour le moment (cocher si vous ne connaissez pas le lieu) Nom du centre hospitalier, nom du CHSLD, \u00e0 domicile, autre. *Adresse pr\u00e9vu du d\u00e9c\u00e8s *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 \u00c9tat matrimonial au moment du d\u00e9c\u00e8s * C\u00e9libataire Mari\u00e9 Veuf Divorc\u00e9 Uni civilement Ex-conjoint d&#8217;union civile Voir la d\u00e9finition des types d&#8217;unions sur le site du Directeur de l&#8217;\u00e9tat civilSuivant Section 2: Renseignements sur le 2i\u00e8me contact Dans l&#8217;\u00e9ventualit\u00e9 ou services fun\u00e9raires Azur serait incapable de joindre le client, une 2i\u00e8me personne \u00e0 contacter doit \u00eatre ajout\u00e9 \u00e0 votre dossier. Merci de remplir la section, Renseignement sur le 2i\u00e8me contact.Quelques est votre lien par rapport \u00e0 cette personne? * Conjoint(e) Fr\u00e8re Soeur P\u00e8re M\u00e8re Ami Autre Pr\u00e9cisez le lien. *Nom du 2i\u00e8me contact *Pr\u00e9nomNomNom de famille \u00e0 la naissanceAdresse (2i\u00e8me contact)Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays1er T\u00e9l\u00e9phone (2i\u00e8me contact)2e T\u00e9l\u00e9phone (2i\u00e8me contact)Telephone 4Telephone 5Courriel (2i\u00e8me contact) *Pr\u00e9c\u00e9dentSuivant Section 3: Renseignements sur l&#039;\u00e9poux (ou l&#039;ex-\u00e9poux) ou le conjoint d&#039;union civile (ou l&#039;ex-conjoint d&#039;union civile) Remplissez cette section si la personne est mari\u00e9e, unie civilement, veuve ou divorc\u00e9e ou que son union civile \u00e9tait dissoute. Vous avez indiqu\u00e9 \u00eatre c\u00e9libataire. Passez \u00e0 la section 3. Cette section ne s&#8217;applique pas \u00e0 vous. Appuyez sur suivant pour passer \u00e0 la prochaine section.Nom de famille \u00e0 la naissancePr\u00e9nom(Commencer par le pr\u00e9nom usuel. S\u00e9parez chacun des pr\u00e9noms par une virgule.)Sexe Masculin F\u00e9minin Date de naissanceJ12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissanceLieu de l&#039;inscription de la naissanceLieu de l&#039;inscription du mariage ou de l&#039;union civile(lieu de culte, paroisse, ville, village ou municipalit\u00e9, province ou\" \/>\n<meta property=\"og:url\" content=\"https:\/\/azurdeces.com\/en\/prearrangements\/\" \/>\n<meta property=\"og:site_name\" content=\"Services fun\u00e9raires Azur incin\u00e9ration\" \/>\n<meta property=\"article:modified_time\" content=\"2026-10-23T11:23:42+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/azurdeces.com\/wp-content\/uploads\/2022\/02\/Logo_Postes_Canada.svg-1.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"16 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/prearrangements\\\/\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/prearrangements\\\/\",\"name\":\"Funeral arrangements without payment before death - 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Directeur fun\u00e9raire : Denis Lachance. IMPORTANT -Lisez les renseignements g\u00e9n\u00e9raux et les directives qui accompagnent ce formulaire. -Remplissez toutes les sections du formulaire. Date_creationPrixRemplissez-vous cette demande d&#039;arrangement fun\u00e9raire pour quelqu&#039;un d&#039;autre ou pour vous-m\u00eame? * Moi-m\u00eame Quelqu&#8217;un d&#8217;autre Personne \u00e0 contacter en priorit\u00e9 * Client (vous-m\u00eame) 2i\u00e8me contact Personne \u00e0 contacter en priorit\u00e9 * Client 2i\u00e8me contact (vous-m\u00eame) Section 1: Renseignements sur le client Nom de famille \u00e0 la naissance *Pr\u00e9nom *Autres pr\u00e9noms (S\u00e9parer chacun des pr\u00e9noms par une virgule)Adresse du domicile *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 T\u00e9l\u00e9phone domicileT\u00e9l\u00e9phone mobileSexe * Masculin F\u00e9minin Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Poids estim\u00e90 &#8211; 100 lbs100 &#8211; 125 lbs125 &#8211; 150 lbs150 &#8211; 175 lbs175 &#8211; 200 lbs200 &#8211; 225 lbs225 &#8211; 250 lbs250 &#8211; 275 lbs275 &#8211; 300 lbs300 &#8211; 325 lbs325 &#8211; 350 lbs350 &#8211; 375 lbs375 &#8211; 400 lbs400 &#8211; 425 lbs425 &#8211; 450 lbs450 &#8211; 475 lbsLieu de naissance *Lieu de l&#039;inscription de la naissance *Nom de famille du parent \u00e0 la naissancePr\u00e9nom du parentQualit\u00e9 du parent P\u00e8re M\u00e8re Nom de famille l&#039;autre parent \u00e0 la naissancePr\u00e9nom de l&#039;autre parentQualit\u00e9 de l&#039;autre parent P\u00e8re M\u00e8re Date pr\u00e9vue du d\u00e9c\u00e8s Date \u00e0 venir (cocher si vous ne connaissez pas la date) Date pr\u00e9vue du d\u00e9c\u00e8s *DateHeureLieu pr\u00e9vu du d\u00e9c\u00e8s Lieu inconnu pour le moment (cocher si vous ne connaissez pas le lieu) Nom du centre hospitalier, nom du CHSLD, \u00e0 domicile, autre. *Adresse pr\u00e9vu du d\u00e9c\u00e8s *Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays Afin d&#8217;\u00e9viter des erreurs, SVP trouver votre adresse avec l&#8217;outil de Poste Canada.\u00a0\u00a0 \u00c9tat matrimonial au moment du d\u00e9c\u00e8s * C\u00e9libataire Mari\u00e9 Veuf Divorc\u00e9 Uni civilement Ex-conjoint d&#8217;union civile Voir la d\u00e9finition des types d&#8217;unions sur le site du Directeur de l&#8217;\u00e9tat civilSuivant Section 2: Renseignements sur le 2i\u00e8me contact Dans l&#8217;\u00e9ventualit\u00e9 ou services fun\u00e9raires Azur serait incapable de joindre le client, une 2i\u00e8me personne \u00e0 contacter doit \u00eatre ajout\u00e9 \u00e0 votre dossier. Merci de remplir la section, Renseignement sur le 2i\u00e8me contact.Quelques est votre lien par rapport \u00e0 cette personne? * Conjoint(e) Fr\u00e8re Soeur P\u00e8re M\u00e8re Ami Autre Pr\u00e9cisez le lien. *Nom du 2i\u00e8me contact *Pr\u00e9nomNomNom de famille \u00e0 la naissanceAdresse (2i\u00e8me contact)Adresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLibyeLib\u00e9riaLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalaosPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Pierre et MiquelonSaint-Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPays1er T\u00e9l\u00e9phone (2i\u00e8me contact)2e T\u00e9l\u00e9phone (2i\u00e8me contact)Telephone 4Telephone 5Courriel (2i\u00e8me contact) *Pr\u00e9c\u00e9dentSuivant Section 3: Renseignements sur l&#039;\u00e9poux (ou l&#039;ex-\u00e9poux) ou le conjoint d&#039;union civile (ou l&#039;ex-conjoint d&#039;union civile) Remplissez cette section si la personne est mari\u00e9e, unie civilement, veuve ou divorc\u00e9e ou que son union civile \u00e9tait dissoute. Vous avez indiqu\u00e9 \u00eatre c\u00e9libataire. Passez \u00e0 la section 3. Cette section ne s&#8217;applique pas \u00e0 vous. Appuyez sur suivant pour passer \u00e0 la prochaine section.Nom de famille \u00e0 la naissancePr\u00e9nom(Commencer par le pr\u00e9nom usuel. S\u00e9parez chacun des pr\u00e9noms par une virgule.)Sexe Masculin F\u00e9minin Date de naissanceJ12345678910111213141516171819202122232425262728293031M123456789101112A2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissanceLieu de l&#039;inscription de la naissanceLieu de l&#039;inscription du mariage ou de l&#039;union civile(lieu de culte, paroisse, ville, village ou municipalit\u00e9, province ou","og_url":"https:\/\/azurdeces.com\/en\/prearrangements\/","og_site_name":"Services fun\u00e9raires Azur incin\u00e9ration","article_modified_time":"2026-10-23T11:23:42+00:00","og_image":[{"url":"https:\/\/azurdeces.com\/wp-content\/uploads\/2022\/02\/Logo_Postes_Canada.svg-1.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"16 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/azurdeces.com\/en\/prearrangements\/","url":"https:\/\/azurdeces.com\/en\/prearrangements\/","name":"Funeral arrangements without payment before death - 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