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Synagogue & Services

Chabad Kevura Burial Form

Officiating Rabbi: Rabbi Shmuel Marcus
State of California Rabbis fee: $800
Name of deceased:
First NameLast Name
Hebrew name and father’s name of Deceased:
Date and time of passing:
MonthDayYear
at HourMinutes
Location of service:
Graveside or chapel:
Spouse:
First NameLast Name
Children:
Separate with comma
Brothers:
Separate with comma
Sisters:
Separate with comma
Grandchildren:
Separate with comma
Psalms:
Eulogy:
Eshet Chayil:
Kriah:
Kaddish:
Nichum:
Shiva:
Payment amount:*
$800
I would Like to donate an additional amount of:
$
Total:
$0.00

Payment:

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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