! colspan="5" style="background-color: #BDBDBD; color: #000000; font-size:120%; padding:0.5em;" | {{{name|{{PAGENAME}}}}}
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! colspan="52" |{{#if:{{{image|}}}|{{{image|}}}}}
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! colspan="5" style="background-color: #BDBDBD; color: #000000; padding:0em;" | General Information