{"id":17702,"date":"2022-03-09T13:56:45","date_gmt":"2022-03-09T18:56:45","guid":{"rendered":"https:\/\/lopeza.net\/?page_id=17702"},"modified":"2024-06-26T11:20:01","modified_gmt":"2024-06-26T15:20:01","slug":"local","status":"publish","type":"page","link":"https:\/\/lopeza.net\/en\/local\/","title":{"rendered":"Worksheet Lopeza services"},"content":{"rendered":"<p>Please complete the following information <\/p>\n\n\n<div class=\"frm_forms  with_frm_style frm_style_estilos-formidable\" id=\"frm_form_38_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form\" id=\"form_lopezaservices\" action=\"\" >\n<div class=\"frm_form_fields  form-group\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Lopeza Services<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"38\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_38\" id=\"frm_hide_fields_38\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"lopezaservices\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_38\" name=\"frm_submit_entry_38\" value=\"9864f91049\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/17702\" \/><div id=\"frm_field_7008_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Impuestos \/ Taxes:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7013_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <div  id=\"field_m9npa_label\" class=\"frm_primary_label control-label\">Tax payer name:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_m9npa_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tTax payer name:\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_7013\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_7013-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_m9npa_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tName\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_m9npa_first\" value=\"\" name=\"item_meta[7013][first]\" autocomplete=\"given-name\" data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nombre del Taxpayer: is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_7013_first_desc\">Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_7013-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_m9npa_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tApellidos\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_m9npa_last\" value=\"\" name=\"item_meta[7013][last]\" autocomplete=\"family-name\" data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nombre del Taxpayer: is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_7013_last_desc\">Apellidos<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7010_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_half\">\r\n    <label for=\"field_3cftg\" id=\"field_3cftg_label\" class=\"frm_primary_label control-label\">LOPEZA customer number:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_3cftg\" name=\"item_meta[7010]\" value=\"\" data-sectionid=\"7008\"  data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"999999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7075_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <div  id=\"field_sm7kh_label\" class=\"frm_primary_label control-label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_sm7kh_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_7075-line1_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_sm7kh_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_sm7kh_line1\" value=\"\" name=\"item_meta[7075][line1]\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Direcci\u00f3n is invalid\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_7075-line2_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_sm7kh_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_sm7kh_line2\" value=\"\" name=\"item_meta[7075][line2]\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Direcci\u00f3n is invalid\" class=\"form-control frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_7075-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_sm7kh_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_sm7kh_city\" value=\"\" name=\"item_meta[7075][city]\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Direcci\u00f3n is invalid\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_7075-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_sm7kh_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tEstate\t<\/label>\n\t\t\t<select name=\"item_meta[7075][state]\" id=\"field_sm7kh_state\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Direcci\u00f3n is invalid\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Estate<\/div><\/div>\n<div id=\"frm_field_7075-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_sm7kh_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip-code\t<\/label>\n\t\t<input type=\"text\" id=\"field_sm7kh_zip\" value=\"\" name=\"item_meta[7075][zip]\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Direcci\u00f3n is invalid\" class=\"form-control\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip-code<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7011_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_xfjvw\" id=\"field_xfjvw_label\" class=\"frm_primary_label control-label\">Phone:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_xfjvw\" name=\"item_meta[7011]\" value=\"\"  data-sectionid=\"7008\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Tel\u00e9fono no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7012_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_first frm_half\">\r\n    <label for=\"field_gxe3x\" id=\"field_gxe3x_label\" class=\"frm_primary_label control-label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_gxe3x\" name=\"item_meta[7012]\" value=\"\"  data-sectionid=\"7008\"  data-invmsg=\"Correo electr\u00f3nico no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_conf_7012_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  form-group frm_top_container  frm6\">\r\n    <label for=\"field_conf_gxe3x\" id=\"field_conf_gxe3x_label\" class=\"frm_conf_label frm_primary_label control-label\">Confirm Correo electr\u00f3nico\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_conf_gxe3x\" name=\"item_meta[conf_7012]\" value=\"\"  data-sectionid=\"7008\"  data-confmsg=\"Los valores introducidos no coinciden\" data-invmsg=\"Correo electr\u00f3nico no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7269_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_half\">\r\n    <label for=\"field_oe9j\" id=\"field_oe9j_label\" class=\"frm_primary_label control-label\">Fecha de nacimiento:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_oe9j\" name=\"item_meta[7269]\" value=\"\"  data-sectionid=\"7008\"  data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7017_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_z9xw_label\" class=\"frm_primary_label control-label\">Spouse: \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_z9xw_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7017-0\">\t\t\t<label  for=\"field_z9xw-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7017]\" id=\"field_z9xw-0\" value=\"Si\"\n\t\t   data-frmval=\"No\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"C\u00f3nyuge:  is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7017-1\">\t\t\t<label  for=\"field_z9xw-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7017]\" id=\"field_z9xw-1\" value=\"No\"\n\t\tchecked=\"checked\"   data-frmval=\"No\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"C\u00f3nyuge:  is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7270_container\" class=\"frm_form_field form-field  form-group frm_top_container frm_half\">\r\n    <label for=\"field_8gn2b\" id=\"field_8gn2b_label\" class=\"frm_primary_label control-label\">Spouse Date of Birth: \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_8gn2b\" name=\"item_meta[7270]\" value=\"\"  data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7019_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_three_col\">\r\n    <div  id=\"field_r1n9s_label\" class=\"frm_primary_label control-label\">Form of presentation:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_r1n9s_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7019-0\">\t\t\t<label  for=\"field_r1n9s-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7019]\" id=\"field_r1n9s-0\" value=\"Soltero\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Forma de presentaci\u00f3n: is invalid\"  \/> Single<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7019-1\">\t\t\t<label  for=\"field_r1n9s-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7019]\" id=\"field_r1n9s-1\" value=\"Casado reportando juntos\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Forma de presentaci\u00f3n: is invalid\"  \/> Married reporting together<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7019-2\">\t\t\t<label  for=\"field_r1n9s-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7019]\" id=\"field_r1n9s-2\" value=\"Casado reportando separados\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Forma de presentaci\u00f3n: is invalid\"  \/> Married Reporting Separated<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7019-3\">\t\t\t<label  for=\"field_r1n9s-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7019]\" id=\"field_r1n9s-3\" value=\"Jefe de hogar\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Forma de presentaci\u00f3n: is invalid\"  \/> Head of household<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7019-4\">\t\t\t<label  for=\"field_r1n9s-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7019]\" id=\"field_r1n9s-4\" value=\"Otro\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Forma de presentaci\u00f3n: is invalid\"  \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7020_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_21pcj_label\" class=\"frm_primary_label control-label\">Has dependents: \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_21pcj_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7020-0\">\t\t\t<label  for=\"field_21pcj-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7020]\" id=\"field_21pcj-0\" value=\"Si\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Posee dependientes:  is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7020-1\">\t\t\t<label  for=\"field_21pcj-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7020]\" id=\"field_21pcj-1\" value=\"No\"\n\t\t   data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Posee dependientes:  is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7090_container\" class=\"frm_form_field form-field  form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_vswce\" id=\"field_vswce_label\" class=\"frm_primary_label control-label\">How many dependents do you have:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_vswce\" name=\"item_meta[7090]\" value=\"\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7015_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Dependents<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[7015][form]\" value=\"39\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_7015-0\" class=\"frm_repeat_sec frm_repeat_7015 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[7015][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[7015][0][0]\" value=\"\" \/><div id=\"frm_field_7021-7015-0_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_field_7021_container\">\r\n    <div  id=\"field_tnczg-0_label\" class=\"frm_primary_label control-label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_tnczg-0_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tName\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_7021\" data-name-layout=\"first_middle_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_7021-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm4\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_tnczg-0_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tName\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_tnczg-0_first\" value=\"\" name=\"item_meta[7015][0][7021][first]\" data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nombre is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_7021_first_desc\">Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_7021-middle_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-middle  frm4\"\n\t\t\t\tdata-sub-field-name=\"middle\"\n\t\t\t>\n\t\t\t\t<label for=\"field_tnczg-0_middle\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tMiddle name or initial\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_tnczg-0_middle\" value=\"\" name=\"item_meta[7015][0][7021][middle]\" data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nombre is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_7021_middle_desc\">Middle name or initial<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_7021-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm4\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_tnczg-0_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tApellidos\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_tnczg-0_last\" value=\"\" name=\"item_meta[7015][0][7021][last]\" data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Nombre is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_7021_last_desc\">Apellidos<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7025-7015-0_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_three_col frm_field_7025_container\">\r\n    <div  id=\"field_k5jkt-0_label\" class=\"frm_primary_label control-label\">Relationship:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_k5jkt-0_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7025-7015-0\">\t\t\t<label  for=\"field_k5jkt-0-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7025]\" id=\"field_k5jkt-0-0\" value=\"Hijo(a)\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Parentesco: is invalid\"  \/> Children<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7025-7015-1\">\t\t\t<label  for=\"field_k5jkt-0-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7025]\" id=\"field_k5jkt-0-1\" value=\"Hermano(a)\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Parentesco: is invalid\"  \/> Siblings<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7025-7015-2\">\t\t\t<label  for=\"field_k5jkt-0-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7025]\" id=\"field_k5jkt-0-2\" value=\"Esposa(o)\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Parentesco: is invalid\"  \/> wife or Husband<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7025-7015-3\">\t\t\t<label  for=\"field_k5jkt-0-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7025]\" id=\"field_k5jkt-0-3\" value=\"Padre o Madre\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Parentesco: is invalid\"  \/> Father or Mother<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7025-7015-4\">\t\t\t<label  for=\"field_k5jkt-0-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7025]\" id=\"field_k5jkt-0-4\" value=\"Otro\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Parentesco: is invalid\"  \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7023-7015-0_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio frm_field_7023_container\">\r\n    <div  id=\"field_wzw9m-0_label\" class=\"frm_primary_label control-label\">Has lived with you during the reporting period:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wzw9m-0_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7023-7015-0\">\t\t\t<label  for=\"field_wzw9m-0-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7023]\" id=\"field_wzw9m-0-0\" value=\"Si\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Ha vivido con Ud. durante el periodo reportado: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7023-7015-1\">\t\t\t<label  for=\"field_wzw9m-0-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7015][0][7023]\" id=\"field_wzw9m-0-1\" value=\"No\"\n\t\t   data-sectionid=\"7015\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Ha vivido con Ud. durante el periodo reportado: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons\"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"7015\" aria-label=\"Add\"><svg  viewbox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>plus1<\/title>\n\t<path d=\"M11 5H9v4H5v2h4v4h2v-4h4V9h-4V5zm-1-5a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> A\u00f1adir dependiente<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"7015\" aria-label=\"Remove\"><svg  viewbox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>minus1<\/title>\n\t<path d=\"M5 9v2h10V9H5zm5-9a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Eliminar dependiente<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_7026_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Ingresos<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7033_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first vertical_radio\">\r\n    <div  id=\"field_re746_label\" class=\"frm_primary_label control-label\">Presentation documents:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_re746_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7033-7026-0\">\t\t\t<label  for=\"field_re746-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7033][]\" id=\"field_re746-0\" value=\"Seguro Social\"  data-sectionid=\"7026\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Documentos de presentaci\u00f3n: is invalid\"   aria-required=\"true\"  \/> Social Security<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7033-7026-1\">\t\t\t<label  for=\"field_re746-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7033][]\" id=\"field_re746-1\" value=\"MASS ID\"  data-sectionid=\"7026\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Documentos de presentaci\u00f3n: is invalid\"   \/> MASS ID<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7033-7026-2\">\t\t\t<label  for=\"field_re746-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7033][]\" id=\"field_re746-2\" value=\"ITIN\"  data-sectionid=\"7026\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Documentos de presentaci\u00f3n: is invalid\"   \/> ITIN<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7033-7026-3\">\t\t\t<label  for=\"field_re746-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7033][]\" id=\"field_re746-3\" value=\"Aplicar o renovar ITIN\"  data-sectionid=\"7026\"  data-frmlimit=\"1\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Documentos de presentaci\u00f3n: is invalid\"   \/> Aplicar o renovar ITIN<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7271_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_sjgo6\" id=\"field_sjgo6_label\" class=\"frm_primary_label control-label\">Date of entry to the United States:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_sjgo6\" name=\"item_meta[7271]\" value=\"\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7285_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_u1k69\" id=\"field_u1k69_label\" class=\"frm_primary_label control-label\">Adjuntar copia de pasaporte: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7285][]\"  value=\"\"  data-frmfile=\"7285\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7285_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7285[]\" id=\"field_u1k69\"\n\t\t\t data-frmfile=\"7285\" multiple=\"multiple\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar copia de pasaporte: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar copia de pasaporte: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7028_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first frm_three_col\">\r\n    <div  id=\"field_148wj_label\" class=\"frm_primary_label control-label\">Select one or more options (according to your case):\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_148wj_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-0\">\t\t\t<label  for=\"field_148wj-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-0\" value=\"W2\/W2G\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   aria-required=\"true\"  \/> W2\/W2G<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-1\">\t\t\t<label  for=\"field_148wj-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-1\" value=\"1099R\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1099R<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-2\">\t\t\t<label  for=\"field_148wj-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-2\" value=\"1099G\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1099G<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-3\">\t\t\t<label  for=\"field_148wj-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-3\" value=\"1099B\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1099B<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-4\">\t\t\t<label  for=\"field_148wj-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-4\" value=\"1099R\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1099R<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-5\">\t\t\t<label  for=\"field_148wj-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-5\" value=\"1099 INT\/DIV\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1099 INT\/DIV<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-6\">\t\t\t<label  for=\"field_148wj-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-6\" value=\"SSA-1099\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> SSA-1099<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7028-7026-7\">\t\t\t<label  for=\"field_148wj-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7028][]\" id=\"field_148wj-7\" value=\"1098T Tuition\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Selecciona una o varias opciones (de acuerdo a su caso): is invalid\"   \/> 1098T Tuition<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7266_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_xe7d\" id=\"field_xe7d_label\" class=\"frm_primary_label control-label\">Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7266][]\"  value=\"\"  data-frmfile=\"7266\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7266_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7266[]\" id=\"field_xe7d\"\n\t\t\t data-frmfile=\"7266\" multiple=\"multiple\"  data-sectionid=\"7026\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7073_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Impuestos de Negocio o Contratista<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7050_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_up5bv_label\" class=\"frm_primary_label control-label\">Reporta Negocio o Contratista\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_up5bv_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7050-7073-0\">\t\t\t<label  for=\"field_up5bv-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7050][]\" id=\"field_up5bv-0\" value=\"Si\"  data-sectionid=\"7073\"  data-frmval=\"{&quot;1&quot;:&quot;No&quot;}\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Reporta Negocio o Contratista is invalid\"   aria-required=\"true\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7050-7073-1\">\t\t\t<label  for=\"field_up5bv-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7050][]\" id=\"field_up5bv-1\" value=\"No\" checked=\"checked\"  data-sectionid=\"7073\"  data-frmval=\"{&quot;1&quot;:&quot;No&quot;}\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Reporta Negocio o Contratista is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7048_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Impuestos de negocio o contratista (continuaci\u00f3n)&#8230;<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7281_container\" class=\"frm_form_field form-field  form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_6h8p7_label\" class=\"frm_primary_label control-label\">Ingreso\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6h8p7_label\" role=\"group\">\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7281-7048-3\">\t\t\t<label  for=\"field_6h8p7-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7281][]\" id=\"field_6h8p7-3\" value=\"1099 Misc\"  data-sectionid=\"7048\"  data-invmsg=\"Ingreso is invalid\"   \/> 1099 Misc<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7281-7048-0\">\t\t\t<label  for=\"field_6h8p7-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7281][]\" id=\"field_6h8p7-0\" value=\"1099K\"  data-sectionid=\"7048\"  data-invmsg=\"Ingreso is invalid\"   \/> 1099K<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7281-7048-1\">\t\t\t<label  for=\"field_6h8p7-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7281][]\" id=\"field_6h8p7-1\" value=\"1099NEC\"  data-sectionid=\"7048\"  data-invmsg=\"Ingreso is invalid\"   \/> 1099NEC<\/label><\/div>\n\t\t<div class=\"frm_checkbox checkbox\" id=\"frm_checkbox_7281-7048-2\">\t\t\t<label  for=\"field_6h8p7-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[7281][]\" id=\"field_6h8p7-2\" value=\"Cash\"  data-sectionid=\"7048\"  data-invmsg=\"Ingreso is invalid\"   \/> Cash<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7051_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_1frak\" id=\"field_1frak_label\" class=\"frm_primary_label control-label\">Adjuntar formularios de negocios: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7051][]\"  value=\"\"  data-frmfile=\"7051\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7051_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7051[]\" id=\"field_1frak\"\n\t\t\t data-frmfile=\"7051\" multiple=\"multiple\"  data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar formularios de negocios: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo o haz una fotograf\u00eda aqu\u00ed:. Maximum file size: 5MB\">Drag a file or take a photo here:<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar formularios de negocios: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7052_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_i0m47\" id=\"field_i0m47_label\" class=\"frm_primary_label control-label\">cash income:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_i0m47\" name=\"item_meta[7052]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7053_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_bqsal\" id=\"field_bqsal_label\" class=\"frm_primary_label control-label\">Material expenses:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_bqsal\" name=\"item_meta[7053]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7267_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_zjv9g\" id=\"field_zjv9g_label\" class=\"frm_primary_label control-label\">Gastos Contratistas:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_zjv9g\" name=\"item_meta[7267]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7054_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_kru4c\" id=\"field_kru4c_label\" class=\"frm_primary_label control-label\">Rent expenses:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_kru4c\" name=\"item_meta[7054]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7055_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_6e1v5\" id=\"field_6e1v5_label\" class=\"frm_primary_label control-label\">Mobile Phone Expense:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_6e1v5\" name=\"item_meta[7055]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7056_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_byilj\" id=\"field_byilj_label\" class=\"frm_primary_label control-label\">Cost of work clothes:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_byilj\" name=\"item_meta[7056]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7057_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_g1d7v\" id=\"field_g1d7v_label\" class=\"frm_primary_label control-label\">Gas expense:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_g1d7v\" name=\"item_meta[7057]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7058_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_bbh6s\" id=\"field_bbh6s_label\" class=\"frm_primary_label control-label\">Electrical energy expense:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_bbh6s\" name=\"item_meta[7058]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7275_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_20lzr_label\" class=\"frm_primary_label control-label\">Reporta veh\u00edculo:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_20lzr_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7275-7048-0\">\t\t\t<label  for=\"field_20lzr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7275]\" id=\"field_20lzr-0\" value=\"Si\"\n\t\t   data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Reporta veh\u00edculo: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7275-7048-1\">\t\t\t<label  for=\"field_20lzr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7275]\" id=\"field_20lzr-1\" value=\"No\"\n\t\t   data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Reporta veh\u00edculo: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7272_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_wi7s7\" id=\"field_wi7s7_label\" class=\"frm_primary_label control-label\">Modelo\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_wi7s7\" name=\"item_meta[7272]\" value=\"\"  data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7276_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_b6c4k\" id=\"field_b6c4k_label\" class=\"frm_primary_label control-label\">Precio\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_b6c4k\" name=\"item_meta[7276]\" value=\"\" data-sectionid=\"7273\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7277_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_dekxv\" id=\"field_dekxv_label\" class=\"frm_primary_label control-label\">Fecha de compra\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_dekxv\" name=\"item_meta[7277]\" value=\"\"  data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7278_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_m559z\" id=\"field_m559z_label\" class=\"frm_primary_label control-label\">Millaje a fecha de compra\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_m559z\" name=\"item_meta[7278]\" value=\"\" data-sectionid=\"7273\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7279_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_xf7i4\" id=\"field_xf7i4_label\" class=\"frm_primary_label control-label\">Millaje a finalizar\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_xf7i4\" name=\"item_meta[7279]\" value=\"\" data-sectionid=\"7048\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7263_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">house taxes<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7264_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_6zwh6_label\" class=\"frm_primary_label control-label\">1098 INT (Mortgage Company)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6zwh6_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7264-7263-0\">\t\t\t<label  for=\"field_6zwh6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7264]\" id=\"field_6zwh6-0\" value=\"Si\"\n\t\t   data-sectionid=\"7263\"  data-frmval=\"No\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1098 INT (Mortgage Company) is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7264-7263-1\">\t\t\t<label  for=\"field_6zwh6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7264]\" id=\"field_6zwh6-1\" value=\"No\"\n\t\tchecked=\"checked\"   data-sectionid=\"7263\"  data-frmval=\"No\" data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1098 INT (Mortgage Company) is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7280_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_je71o\" id=\"field_je71o_label\" class=\"frm_primary_label control-label\">Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7263\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7280][]\"  value=\"\"  data-frmfile=\"7280\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7280_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7280[]\" id=\"field_je71o\"\n\t\t\t data-frmfile=\"7280\" multiple=\"multiple\"  data-sectionid=\"7263\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar documentaci\u00f3n: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7036_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Home taxes (continued)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7047_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_skfd8\" id=\"field_skfd8_label\" class=\"frm_primary_label control-label\">Date of purchase (provide package delivered at purchase):\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_skfd8\" name=\"item_meta[7047]\" value=\"\"  data-sectionid=\"7036\"  maxlength=\"10\" data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Fecha no es v\u00e1lido\" class=\"frm_date form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7039_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_j8j7d\" id=\"field_j8j7d_label\" class=\"frm_primary_label control-label\">Rental Income:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_j8j7d\" name=\"item_meta[7039]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7040_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_l6r5w\" id=\"field_l6r5w_label\" class=\"frm_primary_label control-label\">Loan interest:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_l6r5w\" name=\"item_meta[7040]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7041_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_e2995\" id=\"field_e2995_label\" class=\"frm_primary_label control-label\">Real estate Tax:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_e2995\" name=\"item_meta[7041]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7042_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_j5xiv\" id=\"field_j5xiv_label\" class=\"frm_primary_label control-label\">Hazard Insurance:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_j5xiv\" name=\"item_meta[7042]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7043_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_r20f0\" id=\"field_r20f0_label\" class=\"frm_primary_label control-label\">Water:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_r20f0\" name=\"item_meta[7043]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7044_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first\">\r\n    <label for=\"field_qlfsc\" id=\"field_qlfsc_label\" class=\"frm_primary_label control-label\">Repairs:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_qlfsc\" name=\"item_meta[7044]\" value=\"\" data-sectionid=\"7036\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7071_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Expenses \/ Gastos <\/h3>\r\n\r\n\r\n<div id=\"frm_field_7029_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_rj2v5\" id=\"field_rj2v5_label\" class=\"frm_primary_label control-label\">Rent expenses:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_rj2v5\" name=\"item_meta[7029]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"99999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7030_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_4izjt\" id=\"field_4izjt_label\" class=\"frm_primary_label control-label\">Transportation:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_4izjt\" name=\"item_meta[7030]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"99999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7031_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_t2zwr\" id=\"field_t2zwr_label\" class=\"frm_primary_label control-label\">E-ZPass:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_t2zwr\" name=\"item_meta[7031]\" value=\"\" data-sectionid=\"7077\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"999999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7080_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ttoas\" id=\"field_ttoas_label\" class=\"frm_primary_label control-label\">Donations:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_ttoas\" name=\"item_meta[7080]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7032_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n    <label for=\"field_i921f\" id=\"field_i921f_label\" class=\"frm_primary_label control-label\">Other expenses:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_i921f\" name=\"item_meta[7032]\" value=\"\" data-sectionid=\"7077\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7083_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_xlykn_label\" class=\"frm_primary_label control-label\">Gastos estudiantiles:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_xlykn_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7083-7071-0\">\t\t\t<label  for=\"field_xlykn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7083]\" id=\"field_xlykn-0\" value=\"Si\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Gastos estudiantiles: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7083-7071-1\">\t\t\t<label  for=\"field_xlykn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7083]\" id=\"field_xlykn-1\" value=\"No\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Gastos estudiantiles: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7076_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_5ebkd\" id=\"field_5ebkd_label\" class=\"frm_primary_label control-label\">Gastos estudiantiles (monto anual):  \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_5ebkd\" name=\"item_meta[7076]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"99999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7082_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_hknvg\" id=\"field_hknvg_label\" class=\"frm_primary_label control-label\">Adjuntar 1098T (Gastos estudiantiles): \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7082][]\"  value=\"\"  data-frmfile=\"7082\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7082_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7082[]\" id=\"field_hknvg\"\n\t\t\t data-frmfile=\"7082\" multiple=\"multiple\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar 1098T (Gastos estudiantiles): \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar 1098T (Gastos estudiantiles): \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7084_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_jhr5i_label\" class=\"frm_primary_label control-label\">1098E:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jhr5i_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7084-7071-0\">\t\t\t<label  for=\"field_jhr5i-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7084]\" id=\"field_jhr5i-0\" value=\"Si\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1098E: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7084-7071-1\">\t\t\t<label  for=\"field_jhr5i-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7084]\" id=\"field_jhr5i-1\" value=\"No\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"1098E: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7079_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_3fazu\" id=\"field_3fazu_label\" class=\"frm_primary_label control-label\">1098E (annual amount):\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_3fazu\" name=\"item_meta[7079]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"99999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7085_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_dtyu8\" id=\"field_dtyu8_label\" class=\"frm_primary_label control-label\">Adjuntar 1098E: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7085][]\"  value=\"\"  data-frmfile=\"7085\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7085_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7085[]\" id=\"field_dtyu8\"\n\t\t\t data-frmfile=\"7085\" multiple=\"multiple\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar 1098E: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar 1098E: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7086_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_8ioiu_label\" class=\"frm_primary_label control-label\">Daycare:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8ioiu_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7086-7071-0\">\t\t\t<label  for=\"field_8ioiu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7086]\" id=\"field_8ioiu-0\" value=\"Si\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Daycare: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7086-7071-1\">\t\t\t<label  for=\"field_8ioiu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7086]\" id=\"field_8ioiu-1\" value=\"No\"\n\t\t   data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Daycare: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7081_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm_half\">\r\n    <label for=\"field_k297d\" id=\"field_k297d_label\" class=\"frm_primary_label control-label\">Daycare (annual amount):\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_k297d\" name=\"item_meta[7081]\" value=\"\" data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"99999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7087_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_tb1g8\" id=\"field_tb1g8_label\" class=\"frm_primary_label control-label\">Adjuntar comprobantes Daycare: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7087][]\"  value=\"\"  data-frmfile=\"7087\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7087_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7087[]\" id=\"field_tb1g8\"\n\t\t\t data-frmfile=\"7087\" multiple=\"multiple\"  data-sectionid=\"7071\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar comprobantes Daycare: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar comprobantes Daycare: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7060_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Medical Form<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7062_container\" class=\"frm_form_field form-field  form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_cjcfd_label\" class=\"frm_primary_label control-label\">1095 A\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_cjcfd_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7062-7060-0\">\t\t\t<label  for=\"field_cjcfd-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7062]\" id=\"field_cjcfd-0\" value=\"Si\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 A is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7062-7060-1\">\t\t\t<label  for=\"field_cjcfd-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7062]\" id=\"field_cjcfd-1\" value=\"No\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 A is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7066_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_hu6qw\" id=\"field_hu6qw_label\" class=\"frm_primary_label control-label\">Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7066][]\"  value=\"\"  data-frmfile=\"7066\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7066_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7066[]\" id=\"field_hu6qw\"\n\t\t\t data-frmfile=\"7066\" multiple=\"multiple\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed, toma una foto o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7065_container\" class=\"frm_form_field form-field  form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_uk3n_label\" class=\"frm_primary_label control-label\">1095 B\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_uk3n_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7065-7060-0\">\t\t\t<label  for=\"field_uk3n-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7065]\" id=\"field_uk3n-0\" value=\"Si\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 B is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7065-7060-1\">\t\t\t<label  for=\"field_uk3n-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7065]\" id=\"field_uk3n-1\" value=\"No\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 B is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7064_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_n8mlg\" id=\"field_n8mlg_label\" class=\"frm_primary_label control-label\">Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7064][]\"  value=\"\"  data-frmfile=\"7064\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7064_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7064[]\" id=\"field_n8mlg\"\n\t\t\t data-frmfile=\"7064\" multiple=\"multiple\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed, toma una foto o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7067_container\" class=\"frm_form_field form-field  form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_gyvu7_label\" class=\"frm_primary_label control-label\">1095 \u00abC\u00bb\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_gyvu7_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7067-7060-0\">\t\t\t<label  for=\"field_gyvu7-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7067]\" id=\"field_gyvu7-0\" value=\"Si\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 &quot;C&quot; is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7067-7060-1\">\t\t\t<label  for=\"field_gyvu7-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7067]\" id=\"field_gyvu7-1\" value=\"No\"\n\t\t   data-sectionid=\"7060\"  data-invmsg=\"1095 &quot;C&quot; is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7068_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_54lx1\" id=\"field_54lx1_label\" class=\"frm_primary_label control-label\">Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[7068][]\"  value=\"\"  data-frmfile=\"7068\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file7068_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file7068[]\" id=\"field_54lx1\"\n\t\t\t data-frmfile=\"7068\" multiple=\"multiple\"  data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Arrastra un archivo aqu\u00ed, toma una foto o haz clic para cargar. Maximum file size: 5MB\">Drag a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar documento: \ud83d\uded1  Nunca incluya informaci\u00f3n ni capturas de pantalla de su n\u00famero de Seguro Social o ITIN \ud83d\uded1 . Seleccionar Archivo. Maximum file size: 5MB\">Select File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7069_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_i0z6a_label\" class=\"frm_primary_label control-label\">Masshealth\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_i0z6a_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7069-7060-0\">\t\t\t<label  for=\"field_i0z6a-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7069]\" id=\"field_i0z6a-0\" value=\"Si\"\n\t\t   data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Masshealth is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7069-7060-1\">\t\t\t<label  for=\"field_i0z6a-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7069]\" id=\"field_i0z6a-1\" value=\"No\"\n\t\t   data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Masshealth is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7088_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container vertical_radio\">\r\n    <div  id=\"field_p1en6_label\" class=\"frm_primary_label control-label\">Gastos de dentista:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_p1en6_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7088-7060-0\">\t\t\t<label  for=\"field_p1en6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7088]\" id=\"field_p1en6-0\" value=\"Si\"\n\t\t   data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Gastos de dentista: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7088-7060-1\">\t\t\t<label  for=\"field_p1en6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7088]\" id=\"field_p1en6-1\" value=\"No\"\n\t\t   data-sectionid=\"7060\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Gastos de dentista: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7253_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Deposito Directo<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7255_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm12 frm_first vertical_radio\">\r\n    <div  id=\"field_jvjqf_label\" class=\"frm_primary_label control-label\">Desea deposito directo:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jvjqf_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7255-7253-0\">\t\t\t<label  for=\"field_jvjqf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7255]\" id=\"field_jvjqf-0\" value=\"Si\"\n\t\t   data-sectionid=\"7253\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Desea deposito directo: is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio radio\" id=\"frm_radio_7255-7253-1\">\t\t\t<label  for=\"field_jvjqf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[7255]\" id=\"field_jvjqf-1\" value=\"No\"\n\t\t   data-sectionid=\"7253\"  data-reqmsg=\"Este campo no puede estar en blanco.\" data-invmsg=\"Desea deposito directo: is invalid\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_7256_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Datos Banco:<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7258_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_1obx3\" id=\"field_1obx3_label\" class=\"frm_primary_label control-label\">Nombre del banco:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_1obx3\" name=\"item_meta[7258]\" value=\"\"  data-sectionid=\"7256\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7259_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n    <label for=\"field_7tt38\" id=\"field_7tt38_label\" class=\"frm_primary_label control-label\">Nombre de la cuenta:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7tt38\" name=\"item_meta[7259]\" value=\"\"  data-sectionid=\"7256\"  data-reqmsg=\"Este campo no puede estar en blanco.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7260_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n    <label for=\"field_rule4\" id=\"field_rule4_label\" class=\"frm_primary_label control-label\">N\u00famero de cuenta:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_rule4\" name=\"item_meta[7260]\" value=\"\" data-sectionid=\"7256\"  data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7261_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n    <label for=\"field_hzjw7\" id=\"field_hzjw7_label\" class=\"frm_primary_label control-label\">Routing number:\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_hzjw7\" name=\"item_meta[7261]\" value=\"\" data-sectionid=\"7256\"  data-invmsg=\"N\u00famero no es v\u00e1lido\" class=\"form-control\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<input type=\"hidden\" name=\"item_meta[7171]\" id=\"field_q8axx\" value=\"\"  class=\"form-control\"   \/>\n<input type=\"hidden\" name=\"item_meta[7173]\" id=\"field_dbxyb\" value=\"\"  class=\"form-control\"   \/>\n<div id=\"frm_field_7366_container\" class=\"frm_form_field form-field  form-group\">\r\n\t<div class=\"form-group frm_submit\">\r\n\r\n<button class=\"frm_button_submit btn btn-default frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Send<\/button>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_7367_container\">\n\t\t\t<label for=\"field_gqumu\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_gqumu\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[7367]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"\/bHRv1J92Qep28qNrqTWPl8ia8rvCwm86xoOUDrZaHa\/zwuJRjHEkzh1dsve6+\/z\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Please complete the following information<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-17702","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/pages\/17702","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/comments?post=17702"}],"version-history":[{"count":2,"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/pages\/17702\/revisions"}],"predecessor-version":[{"id":17704,"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/pages\/17702\/revisions\/17704"}],"wp:attachment":[{"href":"https:\/\/lopeza.net\/en\/wp-json\/wp\/v2\/media?parent=17702"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}