|  | {{header}} | 
|  | {{object 1 0}} | 
|  | << | 
|  | /Type /Catalog | 
|  | /Pages 2 0 R | 
|  | /AcroForm << /Fields [ 4 0 R 10 0 R ] /DR 5 0 R >> | 
|  | >> | 
|  | endobj | 
|  | {{object 2 0}} | 
|  | << /Count 1 /Kids [ 3 0 R ] /Type /Pages >> | 
|  | endobj | 
|  | {{object 3 0}} | 
|  | << | 
|  | /Type /Page | 
|  | /Parent 2 0 R | 
|  | /Resources 5 0 R | 
|  | /MediaBox [ 0 0 300 200 ] | 
|  | /Contents 8 0 R | 
|  | /Annots [ 4 0 R 10 0 R ] | 
|  | >> | 
|  | endobj | 
|  | {{object 4 0}} | 
|  | << | 
|  | /Type /Annot | 
|  | /FT /Tx | 
|  | /T (Text Box) | 
|  | /DA (0 0 0 rg /F1 12 Tf) | 
|  | /Rect [ 100 100 200 130 ] | 
|  | /Subtype /Widget | 
|  | /AA << /F 9 0 R >> | 
|  | >> | 
|  | endobj | 
|  | {{object 5 0}} | 
|  | << /Font 6 0 R >> | 
|  | endobj | 
|  | {{object 6 0}} | 
|  | << /F1 7 0 R >> | 
|  | endobj | 
|  | {{object 7 0}} << | 
|  | /Type /Font | 
|  | /Subtype /Type1 | 
|  | /BaseFont /Helvetica | 
|  | >> | 
|  | endobj | 
|  | {{object 8 0}}<< | 
|  | >> | 
|  | stream | 
|  | endstream | 
|  | endobj | 
|  | {{object 9 0}} | 
|  | << /JS (AFNumber_Format\(0, 1, 0, 0, "", false\);) /S /JavaScript >> | 
|  | endobj | 
|  | {{object 10 0}} | 
|  | << | 
|  | /Type /Annot | 
|  | /FT /Tx | 
|  | /T (Text2) | 
|  | /DA (0 0 0 rg /F1 12 Tf) | 
|  | /Rect [ 100 40 200 70 ] | 
|  | /Subtype /Widget | 
|  | >> | 
|  | endobj | 
|  | {{xref}} | 
|  | trailer<< /Root 1 0 R >> | 
|  | {{startxref}} | 
|  | %%EOF |