YAHRZEIT (MEMORIAL) PLAQUE ORDER FORM
| Plaque Information: | ||||
|---|---|---|---|---|
| English Name | (e.g., Joseph Goldsmith) | |||
| Hebrew Name | (e.g., Yosef ben Yaakov) | |||
| Date of Death | (e.g., June 6, 1993) | day or night: | ||
| Hebrew Date of Death | (if known, e.g., 17 Sivan 5753) | |||
| ----------------------------------------------------------------------------------------------------- | ||||
| Purchaser Information:
| ||||
| Name: | ||||
| Phone Number: | ||||
| check enclosed: | ||||
