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