Polk County Itemizer-Observer

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Covering Dallas, Monmouth, Independence, Falls City and surrounding areas since 1868

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birth announcement

This form can be used to submit a birth announcement to the Itemizer-Observer. Each submittal must have a contact name and telephone number where we can verify the information before publication. If we are unable to verify the information we will be unable to publish the announcement.

 

Baby's Details

Baby's Full Name

GenderBoyGirl

Father's Name

Mother's Name

Parents' City/State/ZIP

Time of birth

Date of birth

Baby's weight & length (lbs. oz., in.)

Hospital

Hospital City/St/ZIP

Is this your first child?YesNo

Names & ages of brothers and sisters

Grandparents:
First/last names and towns

Great-grandparents:
First/last names and towns

Great-great-grandparents:
First/last names and towns

Your Contact Information

Contact Name

Physical Address

City/State/ZIP

Email Address

Contact Phone

Work Phone

Enter the code shown: