This image shows a form that mixes dynamic components and static components. The form has two parts: Name, and Address. The Name section has the following fields and values:

• First Name:Scott

• Japanese First Name: Daichi

• Middle Name: Aidan

• Last Name: Smith

• Japanese Last Name: Suzuki

The Address section has the following fields and values:

• Street Address: 123 Main Street

• Japanese Street Address: 456 Capital Street

• City: San Francisco

• Japanese City: Tokyo

• State: CA

• Japanese Province: Tokyo