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Memorial Plaques
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Your First Name
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Your Last Name
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Your Email
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Best number at which to reach you if we have a question?
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Street Address
Apt/Suite
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City
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State
--Select State--
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District of Columbia
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip
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English name to go on plaque
Hebrew name to go on plaque
Spell out in English letters (ex. Shmuel ben Avraham v'Sarah). If you do not know the Hebrew name and it's possible we have the information in temple records, please indicate that here
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English date of passing
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Was passing before or after sundown?
Please Select One
Before Sundown
After Sundown
Hebrew date (if known)
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The Deceased Relationship to You
This person is your ______.
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I agree to donate $360 for this plaque
I agree to donate $360 for this plaque
Total
Notes/Questions?
Tue, October 29 2024 27 Tishrei 5785
