Cemetery Information Form

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If you would like to request information about a specific cemetery plot, provide information, or help with the restoration, Please use the following form.
IMPORTANT: Be sure to fill out all required fields in red type, including your city
and your relationship to deceased.

Contact

Your Name*

Your Email Address*

Address & City (hit + for more lines)*

State*

Zip Code*

Home Phone

Other Phone

Name of Deceased (1) - Last Name, First Name*

Relationship to Deceased (1)*

Name of Deceased (2) - Last Name, First Name

Relationship to Deceased (2)

Name of Deceased (3) - Last Name, First Name

Relationship to Deceased (3)

Name of Deceased (4) - Last Name, First Name

Relationship to Deceased (4)

In addition, I would like to help out in the following way:

Type in the word "Cemetery" below*

If you would like to assist with the restoration of the cemetery donations can be made via our website: Make a Payment. Please make sure to put "Cemetery Restoration Fund" in the item field.

To mail your check directly to the synagogue, our mailing address is: Congregation Poile Zedek, P.O. Box 166, New Brunswick, NJ 08903. Please put "Cemetery Restoration Fund" on the memo line.

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