| style="background-color:#;border-top:solid 0px #000;border-left:solid 0px #000" width="8" |  

| style="background-color:#;border:solid 1px #000;text-align:center;font-weight:bold" width="70" |  {{{1}}}

| style="background-color:#;border-top:solid 0px #000;border-right:solid 0px #000" width="8" |  

| style="border-bottom:0px solid #000" width="3" |