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Today's Date: Tuesday, May 21, 2013
Date of Birth:
Place of Birth:
Name of Parents:
Mothers Maiden Name:
Names and Ages of Siblings:
Paternal Grandparents Home City:
Paternal Great Grandparents:
Paternal Great Grandparents Home City:
Maternal Grandparents Home City:
Maternal Great Grandparents:
Maternal Great Grandparents Home City:
Will you be submitting a photo:
Yes, by email
Yes, by U.S. mail
• A photo may be included with this announcement for $5.00. The photo will run approximately 2 columns by 3 inches, depending on size and quality. Payment must be made before the announcement will run.
• A digital or scanned photo may be attached to email sent to
. Please be sure to include the name of the baby and your contact information in the body of the email.
• A printed photo may be mailed to
Charles City Press, 801 Riverside Drive, Charles City, IA 50616.
Please be sure to include the name of the baby and your contact information on back of the photo.
Contact Information (for newspaper staff use only) ...
Name of person submitting:
For additional information beyond what is included in this form, there is a charge of $5.00 per column inch. Payment must be made before the announcement will run...
Please contact me for additional information:
Billing Information (if photo or additional information is to be included):
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