Shown is a Form 4028-A with a box superimposed on part of the figure listing the fifteen columns as explained in the text: Serial NumberSC or Alpha Block Control NumberFrom CodeTo CodeReinput Source CodeMaster FileBlock DLN (the following five bullets is a listed subset of this on the line below this header)Service Center or District OfficeTax Class and Doc. CodeJulian DateBlock NumberYear Document CountAdjustment Credit AmountAdjustment Debit AmountDLN Serial NumberControl Record Source CodeNew DLN (the following five bullets is listed below this header to be populated)Service Center or District OfficeTax Class or Document CodeJulian DateBlock NumberYearNew DLN Serial NumberNew Master File CodeRemarksTwo rows get populated with data to show an original DLN and the renumber DLN.