Form - Memorial Board Plaques - Chabad of the Bay Area

Your Name* Name of person completing form
First Name Last Name
Please fill out the information below to the best of your knowledge.

Note: Not all information that is on the form will go on the plaque. Some of it is just so we can have a more complete record.

Here's what will go on a typical plaque:
- Name in English
- Date of Passing English & Date of Passing Hebrew
- Hebrew/Jewish first name ben/bat (son/daughter of) parent's Hebrew/Jewish name
Remember: It is common that not all information is known, so don't stress. If you find certain information hard to come by, or simply unknown, you can note that and we will work with what you know.
Memorial Plaque Info
Relationship Doesn't appear on the plaque, just for our records.
Name on Memorial Plaque* Full Name of loved one as you'd like it to appear on the plaque
Date of Passing*

Month Day Year
Time of Passing* Ensures accuracy of Hebrew date for Yahrtzeit. To the best of your knowledge.

Evening (past sunset untill midnight)Day (past midnight or anytime during daylight)Unknown
Hebrew/Jewish Name* If not sure, you can fill in what you know.
Their Father's Name If not sure, fill in what you know.
Hebrew/Yiddish Name First Name Last Name
Their Mother's Name If not sure, fill in what you know.
Hebrew/Yiddish Name First Name Last Name
Note
Should be Empty:

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Form - Memorial Board Plaques