The Coffey County Republican
324 Hudson Street
Burlington, KS 66839
Phone (620) 364-5325
Fax (620) 364-2607
ccrepub@gmail.com

BIRTHDAY ANNOUNCEMENT
	The Coffey County Republican welcomes submission of news items noting milestones of people’s lives, including birthdays of those turning 70 and older at five-year intervals, i.e. 70, 75, 80, etc. A photo is also welcome to be submitted. We prefer electronic submission to ccrepub@gmail.com but can also scan a copy of a photo brought into the office.

Please fill out as completely as possible.

Name:____________________________________________________________________

Address:_________________________________________________________________

Reception date/time/place:_______________________________________________

_________________________________________________________________________

Children:________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Number of grandchildren______ great-grandchildren_____ great-great grandchildren_____

Cards may be mailed to:__________________________________________________

Contact person and phone number__________________________________________