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:
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First Name:
Scott
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Japanese First Name:
Daichi
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Middle Name:
Aidan
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Last Name:
Smith
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Japanese Last Name:
Suzuki
The Address section has the following fields and values:
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Street Address:
123 Main Street
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Japanese Street Address:
456 Capital Street
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City:
San Francisco
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Japanese City:
Tokyo
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State:
CA
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Japanese Province:
Tokyo