<table style="width: 100%;"><tbody><tr><td style="width: 25%;"><br /><br /><br /><br /><br /><br /><br /><span style="font-size: 8pt;">&amp;adm_mairie</span><br /><span style="font-size: 8pt;">&amp;adm_cimetiere</span></td><td style="width: 75%; text-align: center;"><br /><br />
<span style="font-size: 14pt; font-weight: bold;">Titre de recettes provisoire</span><br /><span style="font-weight: bold; font-size: 14pt;">Concession funéraire</span></td></tr></tbody></table>