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Birth Date & Yahrzeit Information Form

Birth Date Information

Birthday
Month
Day
Year

Yahrzeit Information (For a Loved One)

Date of Passing:
Month
Day
Year
Time of Passing (if known):
Time
HoursMinutes
Was the passing before or after sunset?
Before
After

Observance Preferences

Would you like to be reminded annually of this Yahrzeit?
Yes
No
Would you like to sponsor a memorial candle or dedication?
Yes
No
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