<alter> (Semitones)
<measure number="11">
<note>
<pitch>
<step>B</step>
<alter>-2</alter>
<octave>4</octave>
</pitch>
<duration>4</duration>
<voice>1</voice>
<type>eighth</type>
<accidental>flat-flat</accidental>
<stem default-y="-52">down</stem>
<beam number="1">begin</beam>
</note>
<note>
<pitch>
<step>B</step>
<alter>-1</alter>
<octave>4</octave>
</pitch>
<duration>4</duration>
<voice>1</voice>
<type>eighth</type>
<accidental>flat</accidental>
<stem default-y="-52">down</stem>
<beam number="1">continue</beam>
</note>
<note>
<pitch>
<step>B</step>
<octave>4</octave>
</pitch>
<duration>4</duration>
<voice>1</voice>
<type>eighth</type>
<accidental>natural</accidental>
<stem default-y="-52">down</stem>
<beam number="1">continue</beam>
</note>
<note>
<pitch>
<step>B</step>
<alter>1</alter>
<octave>4</octave>
</pitch>
<duration>4</duration>
<voice>1</voice>
<type>eighth</type>
<accidental>sharp</accidental>
<stem default-y="-52">down</stem>
<beam number="1">end</beam>
</note>
<note>
<pitch>
<step>B</step>
<alter>2</alter>
<octave>4</octave>
</pitch>
<duration>8</duration>
<voice>1</voice>
<type>quarter</type>
<accidental>double-sharp</accidental>
<stem default-y="-55">down</stem>
</note>
</measure>