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			<td colspan="2" style="width: 65%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p" style="font-size: 18px; font-weight: 900;">SITUATION - D&Eacute;SIGNATION ET CONSISTANCE DES LOCAUX</span></span></td>
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			<td style="width: 65%;"><span style="font-size:14px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><span style="font-weight:600;">Local principal :<span style="font-size: 12px; font-weight: 200;">&nbsp;</span></span></span></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;df4c9693&quot; data_label=&quot;Local principal&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Local principal&quot; data_choices=&quot;Appartement&nbsp; &nbsp; |Appartement; Maison&nbsp; &nbsp; |Maison; Boutique&nbsp; &nbsp; |Boutique; Autre :&nbsp; &nbsp; |Autre;&quot; %}</span></td>
			<td style="width: 35%;">{% textarea_tag name=&quot;1bb819b2&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;signation local : autre&quot; data_map_field=&quot;nomap&quot; data_help=&quot;D&eacute;signation local&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p">p&eacute;riode de construction :&nbsp;{% radio_tag name=&quot;6925ff1c&quot; data_label=&quot;P&eacute;riode de contruction&quot; data_map_field=&quot;nomap&quot; data_help=&quot;P&eacute;riode de contruction&quot; data_choices=&quot;avant 1949&nbsp;&nbsp;&nbsp;|avant 1949;de 1949 &agrave; 1974&nbsp; |de 1949 &agrave; 1974;de 1975 &agrave; 1989&nbsp; |de 1975 &agrave; 1989;de 1989 &agrave; 2005&nbsp;&nbsp;|de 1989 &agrave; 2005;depuis 2005&nbsp; |depuis 2005;&quot; data_ancien_ids=&quot;25672,25624,25574,25181&quot; %}</span></span></p>

<table border="0" cellpadding="2" cellspacing="2" style="width:40%;">
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			<td style="vertical-align: middle; width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nombre de pi&egrave;ces :</span></td>
			<td style="width: 20%;">{% textinput_tag name=&quot;48d06def&quot; data_label=&quot;Nombre de pi&egrave;ces&quot; data_map_field=&quot;nb_room&quot; data_help=&quot;Nombre de pi&egrave;ces&quot; maxlength=&quot;75&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Superficie :</span></td>
			<td style="width: 20%;">{% textinput_tag name=&quot;4a2a1e71&quot; data_label=&quot;Superficie&quot; data_map_field=&quot;area&quot; data_help=&quot;Superficie&quot; maxlength=&quot;75&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td colspan="6" rowspan="1" style="vertical-align: middle; width: 11%;"><span style="font-size:14px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><span style="font-weight:600;">Annexe(s) :</span></span></span></td>
			<td style="width: 3%; vertical-align: middle;">&nbsp;</td>
			<td style="width: 52%;">&nbsp;</td>
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			<td style="vertical-align: middle; width: 11%;">{% checkbox_tag name=&quot;e9d68161&quot; data_label=&quot;Garage&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Garage&quot; data_ancien_ids=&quot;9283&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Garage n&deg;</span></td>
			<td style="width: 12%;">
			<p>{% textinput_tag name=&quot;ed2502ed&quot; data_label=&quot;Garage n&deg;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Garage n&deg;&quot; maxlength=&quot;15&quot; data_ancien_ids=&quot;9306&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</p>
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			<td style="vertical-align: middle; width: 10%;">&nbsp;{% checkbox_tag name=&quot;608ba1ea&quot; data_label=&quot;Cave&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Cave&quot; data_ancien_ids=&quot;9352&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Cave n&deg; </span></td>
			<td style="vertical-align: middle; width: 12%;">{% textinput_tag name=&quot;01b7e1f3&quot; data_label=&quot;Cave n&deg;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Cave n&deg;&quot; maxlength=&quot;15&quot; data_ancien_ids=&quot;9376&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 17%;">{% checkbox_tag name=&quot;43e5ae48&quot; data_label=&quot;Stationnement n&deg;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Stationnement n&deg;&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Stationnement n&deg;</span></td>
			<td style="width: 10%;">&nbsp;{% textinput_tag name=&quot;8836ffb9&quot; data_label=&quot;stationnement&quot; data_map_field=&quot;nomap&quot; data_help=&quot;stationnement&quot; maxlength=&quot;15&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 3%; vertical-align: middle;">&nbsp;{% checkbox_tag name=&quot;9322c089&quot; data_label=&quot;Annexe autre&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Annexe autre&quot; data_ancien_ids=&quot;9237&quot; %}</td>
			<td style="width: 52%;">{% textinput_tag name=&quot;be58f753&quot; data_label=&quot;Annexe autre&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Annexe autre&quot; maxlength=&quot;60&quot; data_ancien_ids=&quot;9214&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family: ITCAvantGardePro; font-size: 12px;">Immeuble sis &agrave;</span></td>
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			<td>{% textarea_tag name=&quot;202bd211&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du bien&quot; data_map_field=&quot;address&quot; data_help=&quot;Adresse du bien&quot; data_ancien_ids=&quot;4080,1362,9400&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Code postal</span></td>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">ville</span></td>
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			<td>{% numberinput_tag name=&quot;3338693e&quot; data_label=&quot;code postal du logement&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;code postal du logement&quot; maxlength=&quot;5&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td>{% textinput_tag name=&quot;acb93969&quot; data_label=&quot;ville du logement&quot; data_map_field=&quot;city&quot; data_help=&quot;ville du logement&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p"><strong>Description du logement :</strong></span></span></td>
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			<td>{% textarea_tag name=&quot;5b38495c&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;signation du bien &quot; data_map_field=&quot;realty_name&quot; data_help=&quot;D&eacute;signation du bien &quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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				<li style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Information concernant les modalit&eacute;s de r&eacute;ception des services de t&eacute;l&eacute;vision, conform&eacute;ment &agrave; la loi n&deg;89-462 du 06/07/89, art. 3-2 :&nbsp;</span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">possibilit&eacute; de recevoir en clair les services nationaux de t&eacute;l&eacute;vision par voie hertzienne terrestre en mode num&eacute;rique :&nbsp;</span></li>
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			<td style="text-align: right; vertical-align: bottom; width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;29d512f3&quot; data_label=&quot;Possibilit&eacute; de recevoir en clair les services nationaux de t&eacute;l&eacute;vision par voie hertzienne terrestre en mode num&eacute;rique&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Possibilit&eacute; de recevoir en clair les services nationaux de t&eacute;l&eacute;vision par voie hertzienne terrestre en mode num&eacute;rique&quot; data_choices=&quot;Oui |Oui; Non |Non;&quot; %}</span></td>
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				<li style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;claration du bailleur : le bien, objet des pr&eacute;sentes, a-t-il subi un sinistre ayant donn&eacute; lieu au versement d&#39;une indemnit&eacute; d&#39;assurance garantissant :&nbsp;les risques de catastrophes mini&egrave;res, naturelles ou technologiques, vis&eacute;es &agrave; &#39;art. L 125-2 du Code des assurances ? :&nbsp;</span></li>
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			<td style="text-align: right; vertical-align: bottom; width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;d717eeb8&quot; data_label=&quot;Le bien, objet des pr&eacute;sentes, a-t-il subi un sinistre ayant donn&eacute; lieu au versement d&#39;une indemnit&eacute; d&#39;assurance&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Indemnit&eacute; d&#39;assurance&quot; data_choices=&quot;Oui|Oui; Non|Non;&quot; %}</span></td>
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