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Our Shul Yahrzeit

Yarzheit Plaque Order Form

Please fill out as much information as you can.
Your Name*
First Name Last Name
Your E-mail*
Deceased English Name*
Deceased Hebrew Name
Deceased Father's Hebrew Name
Date of Passing (English Date)*

Month Day Year
Time of Passing *

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Hebrew Date of Day of Passing
Location of Passing (US, UK, Austrailia etc..)

Payment*

Credit Card Check

Postal / Zip Code

Country

Cost

$0.00
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