The Coffey County Republican Birth Announcement Form

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Return to: The Coffey County Republican
BIRTH ANNOUNCEMENT
324 Hudson, P.O. Drawer A
Burlington, KS 66839
Please fill out both pages as completely as possible.
620-364-5325
Baby’s name:_________________________________________________________________________
Mother’s name (city, state): ______________________________________________________________
Father’s name (city, state): ______________________________________________________________
Time and date of birth: _________________________________________________________________
Weight:____________ Length:__________ Hospital: _________________________________________
Names/ages of siblings _________________________________________________________________
___________________________________________________________________________________
Maternal grandparents’ and great-grandparents’ names and where they live.
___________________________________________________________________________________
___________________________________________________________________________________
Paternal grandparents’ and great-grandparents’ names and where they live.
___________________________________________________________________________________
___________________________________________________________________________________
Name of person submitting form: _________________________________________________________
Signature: ___________________________________________________________________________
Weekday daytime telephone number:______________________________________________________
Please submit this form to The Coffey County Republican, Drawer A, Burlington, KS 66839 or in per-
son at 324 Hudson, Burlington. You may also send a photo of the baby along with a self-addressed
stamped envelope, or e-mail the photo to . There is no charge for
publishing the announcement and photo.

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