Donation Form - Helping Remember the Souls of the Past

	All checks are tax deductible and should be made out to: Torah V'chaim 128 Fifth Street Lakewood, NJ 08701 1800-653-4416 Please print out this form and mail it to the above address or fax it to 732-901-4303
Yahzreit Package	__ The Yahrzeit package: A Mishnah learned, a Kaddish and a Psalm said on the Yahrzeit of your loved one $50
Kaddish	Please select one: __ Kaddish recited on the Yahrzeit for your loved one $36 __ Kaddish recited on the Yahrzeit for five years $80 __ Kaddish recited on the Yahrzeit for ten years $150 __ Kaddish on the Yahrzeit by all three services $72 __ Kaddish for the entire eleven months $1,800
Psalm	Please select one: __ A Psalm read on the Yahrzeit $18 __ for Illness $18 __ for Health $18 __ for Parnassa (livelihood) $18 __ for Shiduchim $18 __ for Nachas from children $18 __ for Birth $18 __ for Operation $18 __ A Psalm spelling out the deceased name ( per character) $4
Mishnah	Please select one: __ A Mishnah studied on the Yahrzeit $18 __ A chapter of Mishnayos studied on the Yahrzeit $72
Yizkor	Please select one: __ Yizkor recited on Yom Kippur $72 __ Yizkor recited on the next Jewish holiday $56 __ Yizkor recited on all three Jewish holidays per year $150
Blessing	A blessing said for the sick by the Torah reading on Sabbath: __ Said on one Sabbath $18 __ Said four consecutive Sabbaths $36
Dedications	Please select one: __ to dedicate a candle $1,800 __ to dedicate any page $3,600 __ to dedicate the home candle $3,600 __ to dedicate the home page $10,000 Select One: __ Kaddish __ Yizkor __ Naming __ Psalms __ Mishnah __ Dedications for the option -to dedicate any page or the option to dedicate a candle please select a page from the list above.
	All prices above are based on a minimum donation
	To give a tax deductible donation to The Yahrzeit Organization: (please check one)
	__ $18 __ $36 __ $72 __ $108 __ $1,000 __ $10,000 other: $_____

Name: Address: Phone Number: Email Address: City: State: Zip Code:
	__ Credit Card __ Please bill me __ Check Enclosed
	Credit Card #: Expiration Date: ( MM/YY )
	Special Request: if you have a specific prayer you want said email the Rabbi at asktherabbi@yahrzeit.org
	FIRST NAME OF THE DECEASED
	Hebrew:
	English:
	FIRST NAME OF FATHERS NAME OF THE DECEASED If available:
	Hebrew:
	English:
	DATE AND TIME OF DEATH:
	Date: Time:
	LOCATION OF DEATH:
	(Example New York USA.)

	We accept: ... All checks are tax deductible and should be made out to: Cong Son's of Israel 814 Forest Ave Lakewood, NJ 08701 If you have trouble submitting the form above please either mail it to the above address, or print and fax it to 732-901-4303 Any questions please call toll free 1-800-653-4416