The title of the Form is Block Number Control in the upper left corner. To the right is 000-999 for the Blocking Series and to the far right is Page number 1. Second row is File Location Code 00, Tax Class 2, Document Code 21, then Form number and title is 1040, then Program Number is 43110. Below these 2 rows is 006 for the Date, then the Beginning Number in the Block is 002210080000 and the Ending Number is 002210080099. The Item Count is 1 and the Remarks are 1393 for the Batch Control Sequence Number and RB for the initials.