Yahrzeit Memorial Plaque Request

Honor your family member with a Yahrzeit Memorial Plaque on the Yizkor Wall of Heritage Pointe’s K’hilat Horim Synagogue and receive annual commemoration notifications.

Please complete this form below to help us continue to meet the spiritual and congregational needs of our Residents. You may list up to three loved one’s names per plaque.

Deceased Information
English Name to Appear in English on the Plaque
First Middle Last
Transliteration of Hebrew/Yiddish Name
This will appear in Hebrew on the plaque - we will contact you to confirm Hebrew spelling
Hebrew First Name
Ben/Bat
Father's Hebrew name
(Optional)
"Veh"
Mother's Hebrew Name
Select One*
- Kohen
- Levi
- Yisrael
- Not Known
English Date of Death*
Month
Day
Year
Passed (select one)*
Used to determine Hebrew date
- Before Sundown
- After Sundown
Jewish Calendar date If not known, it will be calculated by the Director of Spiritual Life
Jewish Calendar Day of month
Jewish Calendar Month
Jewish Calendar Year
Do you have an additional name to list?
- Yes, I would like to list a second name on this same plaque.
Second Deceased Information
English Name to Appear in English on the Plaque
First Middle Last
Transliteration of Hebrew/Yiddish Name
This will appear in Hebrew on the plaque - we will contact you to confirm Hebrew spelling
Hebrew First Name
Ben/Bat
Father's Hebrew name
(Optional)
"Veh"
Mother's Hebrew name
Select One*
- Kohain
- Levite
- Yisraeli
- Not Known
English Date of Death*
Month
Day
Year
Passed (select one)*
Used to determine Hebrew date
- Before Sundown
- After Sundown
Jewish Calendar date If not known, it will be calculated by the Director of Spiritual Life
Jewish Calandar Day of month
Jewish Calendar Month
Jewish Calendar Year
Do you have an additional name to list?
- Yes, I would like to list a third name on this same plaque.
Third Deceased Information
English Name to Appear in English on the Plaque
First Middle Last
Transliteration of Hebrew/Yiddish Name
This will appear in Hebrew on the plaque - we will contact you to confirm Hebrew spelling
Hebrew First Name
Ben/Bat*
Father's Hebrew Name
(Optional)
"Veh"
Mother's Hebrew Name
Select One*
- Kohain
- Levite
- Yisraeli
- Not Known
English Date of Death*
Month
Day
Year
Passed (select one)*
Used to determine Hebrew date
- Before Sundown
- After Sundown
Jewish Calendar date If not known, it will be calculated by the Director of Spiritual Life
Jewish Calandar Day of month
Jewish Calendar Month
Jewish Calendar Year
Donor/Requestor Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Additional Notifications
If you have additional people you would like to be notified of the purchase of this memorial plaque, please select a quantity up to 5 and list their name and email addresses below.
How many additional people would you like to notify?
Additional Notification 1 Name
First Last
Additional Notification 1 Email
Additional Notification 2 Name
First Last
Additional Notification 2 Email
Additional Notification 3 Name
First Last
Additional Notification 3 Email
Additional Notification 4 Name
First Last
Additional Notification 4 Email
Additional Notification 5 Name
First Last
Additional Notification 5 Email
Payment Information
Yahrzeit Memorial Plaque
Total Cost
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

CONTACT US

(949) 276-6232
27356 Bellogente
Mission Viejo, CA 92691
USA

Residences, Services, Programs and Volunteering

License 300607488
Tax ID: 33-0260314

Terms & Conditions

Privacy & Refund Policies

Navigation

Deceased Information

Second Deceased Information

Third Deceased Information

Donor/Requestor Information

Additional Notifications

Payment Information