YOUNG ISRAEL OF NORTHRIDGE
Memorial Plaque Order Form
English Name of Deceased (First, Last)
Hebrew Name (English transliteration) (son of / daughter of)
(Ex: MOSHE BEN AVRAHAM (HA KOHEN or HA LEVI, blank for Yisrael)
|Kohen , Levi , Israel|
Father's Hebrew Name (English transliteration)
English Date of Death
Before or after Sundown
Hebrew Date of Death
Name of person ordering plaque
relationship to deceased
Home Phone (xxx-xxx-xxxx)
Business Phone (xxx-xxx-xxxx)
|The cost of a Memorial Plaque is $360.00 for members, $460.00 for non-members.|
Plaques will not be ordered until paid for in full. Please allow at least 60 days for delivery.
You will be notified upon placement of the plaque on the Memorial Wall.
Paid: Date: _____________________ Check No. ____________ Plaque Order Date: _____________________
Received Date: _____________________ Notification of family: _____________________
Wall Placement Date: _____________________ Plaque Location: _____________________
Young Israel of Northridge. 17511 Devonshire Street, Northridge, CA 91325
Legacy . .. Community . .. Family . ..