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<!DOCTYPE html> <html> <body> <form action="action_page.php"> <fieldset> <legend>Personal information:</legend> First name:<br> <input type="text" name="firstname" value="Mickey"> <br> Last name:<br> <input type="text" name="lastname" value="Mouse"> <br><br> <input type="submit" value="Submit"> </fieldset> </form> </body> </html>