BIRTHDAY FORM The Journal Times publishes birthday announcements in by Yearoveryear

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									                                      BIRTHDAY FORM
The Journal Times publishes birthday announcements in the Saturday Community section for people
celebrating their 90th birthday, their 95th birthday, 100th birthday and each year after that. A picture can
be supplied by the family or an appointment can be made with The Journal Times Photo Department to
have one taken. Please call Mark Hertzberg, director of photography, at 262-631-1719.

PLEASE PRINT CLEARLY.
Name: ____________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
Maiden Name (if applies): ___________________________________________________________________________________
Birthdate: _________________________________________________________________________________________________
Where Born (city and state): ________________________________________________________________________________
When did you come to Racine: ______________________________________________________________________________
How will your birthday be celebrated, where and when: _______________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Married to: ________________________________________________________________________________________________
When married (date and year): ______________________________________________________________________________
Place of marriage (city and state): ___________________________________________________________________________
___________________________________________________________________________________________________________
If spouse deceased, when: _________________________________________________________________________________
Hobbies, organizations, volunteer work (past and present): ____________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Church affiliations: _________________________________________________________________________________________
Former employment, how long there, when retired: ___________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Names of children, their spouses, where they live — example: Mary (John) Smith of Racine
for a daughter, John (Mary) for a son: ________________________________________________________________________
Number of grandchildren: __________________ great-grandchildren: ________________ great-great: _________________
Anything else you would like us to know: ____________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Have arrangements been made for a picture: ________________________________________________________________
Name and phone number of person filling out form: ___________________________________________________________

If you have any questions, please call Loreen Mohr, Community Coordinator, 262-631-1725. Please bring
or mail this form to: Loreen Mohr, Journal Times, 212 Fourth St., Racine WI 53403

								
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