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[null,null,null,"Veterans\nHigh School Diploma Application",{"$nulls":6},"Form 1076-2013"]
[]
[]
[]
[]
[]
["This application is used to establish the eligibility of honorably discharged  veterans for the receipt of a high school diploma from the state of Florida. The next of kin may apply for the diploma if the veteran is deceased. Please feel free to include any special comments about this veteran on a separate page or the back of this application."]
[]
[]
["****** VETERAN INFORMATION - PLEASE TYPE OR PRINT ******"]
["Veteran's First Name:",null,null,"Veteran's MI:",null,"Veteran's Last Name:",{"$nulls":4},"Suffix (Sr., Jr., etc.):"]
[]
["Home Phone of Veteran or Next of Kin:",{"$nulls":4},"Work Phone of Veteran or Next of Kin:"]
[]
["Do we have your permission to use the Veteran's name for program promotion? (check one)",null,null,null,"Is the Veteran deceased?\n(check one)",null,"If the Veteran is deceased, what is your name and relationship to the Veterans? (spouse, child, grandchild, sibling)"]
[]
[]
["Was the Veteran a resident of the state of Florida at the time of death?",null,null,null,"Current mailing address of Veteran or next of kin making application:"]
["         "]
["VETERAN'S MILITARY SERVICE INFORMATION"]
["Please attach a copy of your DD Form 214"]
["Branch of Service:",null,"Date of Enlistment/Draft:",null,null,"Date Honorably Discharged:",null,null,null,"Service Number:"]
[]
[]
[null,null,"   Month","Day","    Year","     Month","       Day","Year"]
["HIGH SCHOOL INFORMATION"]
["Name of High School attended?",null,null,null,"County where school was located:",null,null,null,"City and state of High School:"]
[]
["I certify that all the information provided on this application and the supporting documentation is true and correct to the best of my knowledge and is to be used for the sole purpose of applying for a State of Florida High School Diploma."]
["Signature of Veteran or Next of Kin",{"$nulls":4},"Notary Public:",{"$nulls":4},"Date:"]
[]
["Date:",{"$nulls":4},"My Commission Expires:"]
[]
[]
["FOR OFFICE USE ONLY:",{"$nulls":6},"PLEASE MAIL TO:"]
[]
["DOE Approval:",null,null,null,"Date:",null,null,"Florida Department of Education"]
[{"$nulls":7},"Veterans High School Diploma Program"]
["Appl. Rec'd.",null,"Diploma Iss.",null,"Diploma Mailed",null,null,"325 West Gaines Street, Room 714"]
[{"$nulls":7},"Tallahassee, Florida  32399-0400"]

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