http://www.villedelens.fr/ fr SPIP - www.spip.net http://www.villedelens.fr/IMG/siteon0.jpg http://www.villedelens.fr/ 100 275 http://www.villedelens.fr/Acte-de-naissance http://www.villedelens.fr/Acte-de-naissance 2008-10-02T06:57:00Z text/html fr Admin Demander en ligne votre acte de naissance - <a href="http://www.villedelens.fr/-Acte-de-naissance-" rel="directory">1. Acte de naissance</a> <div class='rss_texte'><p class="spip"><strong class="spip">Demander en ligne votre acte de naissance</strong></p> <a name='form1'></a> <div class='spip_forms form_1'> <div class='spip_descriptif'></div> <form method='post' action='spip.php?page=backend&id_rubrique=30#form1' enctype='multipart/form-data'> <div> <input name='page' value='backend' type='hidden' /> <input name='id_rubrique' value='30' type='hidden' /> <input type='hidden' name='ajout_reponse' value='1' /> <input type='hidden' name='id_donnee' value='0' /> <input type='hidden' name='retour_form' value='' /> </div> <div > <fieldset class='separateur_1'><legend>Renseignements concernant la naissance</legend> <div class='spip_form_champ ligne_2'> <span class='spip_form_label'> <label for="input-1-ligne_2">Nom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_2' id='input-1-ligne_2' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_10'> <span class='spip_form_label'> <label for="input-1-ligne_10">Nom d'épouse</label> : </span> <input type="text" name='ligne_10' id='input-1-ligne_10' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_3'> <span class='spip_form_label'> <label for="input-1-ligne_3">Prénom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_3' id='input-1-ligne_3' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_1'> <span class='spip_form_label'> <label for="input-1-date_1">Date de naissance (JJ/MM/AAAA)</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='date_1' id='input-1-date_1' value="" class='date-picker date forml' size='40' /> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_2'><legend>Sollicite la délivrance de :</legend> <div class='spip_form_champ select_4'> <span class='spip_form_label'> <span class='label'></span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_4' value='select_4_1' id='input-1-select_4_1' /> <label for='input-1-select_4_1'>Acte(s) plurilingues</label> </li> <li> <input type='radio' name='select_4' value='select_4_2' id='input-1-select_4_2' /> <label for='input-1-select_4_2'>Copie(s) intégrale(s)</label> </li> <li> <input type='radio' name='select_4' value='select_4_3' id='input-1-select_4_3' /> <label for='input-1-select_4_3'>Extrait(s) avec filiation</label> </li> <li> <input type='radio' name='select_4' value='select_4_4' id='input-1-select_4_4' /> <label for='input-1-select_4_4'>Extrait(s) sans filiation</label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ texte_2'> <span class='spip_form_label'> <label for="input-1-texte_2">Motif de la demande</label> : </span> <textarea name='texte_2' rows='10' class='formo ' cols='80' id='input-1-texte_2'></textarea> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_5'> <span class='spip_form_label'> <span class='label'>Nombre</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <select name='select_5' id='input-1-select_5' class='fondl'> <option value=''></option> <option value='select_5_1' > 1 </option> <option value='select_5_2' > 2 </option> <option value='select_5_3' > 3 </option> <option value='select_5_4' > 4 </option> <option value='select_5_5' > 5 </option> </select> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_8'> <span class='spip_form_label'> <label for="input-1-ligne_8">Nom et prénom du père</label> : </span> <input type="text" name='ligne_8' id='input-1-ligne_8' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_9'> <span class='spip_form_label'> <label for="input-1-ligne_9">Nom et prénom de la mère</label> : </span> <input type="text" name='ligne_9' id='input-1-ligne_9' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_1'> Les deux champs ci-dessus sont à remplir obligatoirement pour une copie intégrale ou un extrait avec filiation </div> </fieldset><fieldset class='separateur_3'><legend>Renseignement concernant le demandeur</legend> <div class='spip_form_champ ligne_12'> <span class='spip_form_label'> <label for="input-1-ligne_12">Nom Demandeur</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_12' id='input-1-ligne_12' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_13'> <span class='spip_form_label'> <label for="input-1-ligne_13">Prénom Demandeur</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_13' id='input-1-ligne_13' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_6'> <span class='spip_form_label'> <span class='label'>Vous êtes</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <select name='select_6' id='input-1-select_6' class='fondl'> <option value=''></option> <option value='select_6_1' > Lui-même </option> <option value='select_6_2' > Conjoint(e) </option> <option value='select_6_3' > Ascendant direct (parent) </option> <option value='select_6_4' > Descendant direct (enfant) </option> <option value='select_6_5' > Administration, Notaire, Avocat </option> </select> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ texte_1'> <span class='spip_form_label'> <label for="input-1-texte_1">Adresse</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <textarea name='texte_1' rows='10' class='forml ' cols='80' id='input-1-texte_1'></textarea> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ code_postal_1'> <span class='spip_form_label'> <label for="input-1-code_postal_1">Code Postal</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='code_postal_1' id='input-1-code_postal_1' value="" class=' code_postal forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_4'> <span class='spip_form_label'> <label for="input-1-ligne_4">Ville</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_4' id='input-1-ligne_4' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_11'> <span class='spip_form_label'> <label for="input-1-ligne_11">Pays</label> : </span> <input type="text" name='ligne_11' id='input-1-ligne_11' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_1'> <span class='spip_form_label'> <label for="input-1-email_1">Votre Email</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <input type="text" name='email_1' id='input-1-email_1' value="" class=' email formo' size='40' /> <span class='nettoyeur'> </span> </div> </fieldset> <p style='display:none;'><label for="nobotnobot-1">Veuillez laisser ce champ vide :</label> <input type="text" name="nobotnobot" id="nobotnobot-1" value="" size="10" /></p> <div style='text-align:right' class='spip_bouton'><input type="submit" name='Valider' value="Valider" /> </div> <script src="http://www.villedelens.fr/plugins/forms_et_tables_1_9_1/javascript/jtip.js" type="text/javascript"></script> <script src="http://www.villedelens.fr/plugins/forms_et_tables_1_9_1/javascript/jquery-dom.js" type="text/javascript"></script> <script src="http://www.villedelens.fr/plugins/forms_et_tables_1_9_1/javascript/datePicker.js" type="text/javascript"></script> <script type="text/javascript"><!-- jQuery('div.spip_forms input.formo').bind('focus',function(){jQuery(this).addClass('formo-focus');}); jQuery('div.spip_forms input.formo').bind('blur',function(){jQuery(this).removeClass('formo-focus');}); jQuery('div.spip_forms input.forml').bind('focus',function(){jQuery(this).addClass('forml-focus');}); jQuery('div.spip_forms input.forml').bind('blur',function(){jQuery(this).removeClass('forml-focus');}); $.datePicker.setDateFormat('dmy','/'); $.datePicker.setLanguageStrings( ['dimanche', 'lundi', 'mardi', 'mercredi', 'jeudi', 'vendredi', 'samedi'], ['janvier', 'février', 'mars', 'avril', 'mai', 'juin', 'juillet', 'août', 'septembre', 'octobre', 'novembre', 'décembre'], {p:'précédent', n:'suivant', c:'X'} ); $('input.date-picker').datePicker({startDate:'01/01/1900'}); //--></script> </div> </form> </div> <p class="spip">Hôtel de Ville de LENS <br />17 Bis Place Jean Jaurès <br />62307 LENS Cedex</p> <p class="spip">Téléphone : 03 21 69 86 86</p></div>