Gen.Fiche Info - Jarmi Papos Mateszalka

Please fill out only what you can
Edmond Silber 7453 Ostell Crescent Montreal, QC H4P 1Y7 Canada Tel.: 514-342-5578 Cel. 514-502-6430
Date:_______/____________________20_______
Mr. & Mrs.:__________________________________________________________Tel:(____)________________ Fax:(____)________________
Address:_________________________________________________________________________________Postal code/ZIP______________
Email:__________________________________________
 Husband
Please print
- Mari
x hps v k t b
Last name/Nom de famille:_____________________________________________________________________________________________
First name/Prénom:_________________________________________Hebrew 1st name/Prénom hébreu______________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
birth date/Date de naissance:_________/____________/_______Time/heure:___________am/pm Day/or/after sundown?/avant ou après le coucher de soleil
Year
/
Month
/
day
Place of birth / Lieu de naissance:_____________________________________________________________________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
If deceased: Date of death, place where buried, plot Nbr & some comment:_______/______/______/_________________________________
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
Year
/
Month
/
day
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
 Husband’s FATHER 1st name / MARI, prénom du père:____________________________________________________________________
Husband’s father Hebrew 1st name/Prénom hébreu du père du mari________________________________Ben________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
Husband’s FATHER/date and place of Birth/ Père du mari: date et lieu de naissance:_______/______/______/_______________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
Year
/
Month
/
day
If deceased: Date of death, place where buried, plot Nbr. Some comments._______/______/______/_________________________________
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
Year
/
Month
/
day
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
 Husband's MOTHER 1st & MAIDEN name/ Mère du mari: prénom et NOM DE JEUNE FILLE: _____________________________________
Husband’s Mother Hebrew 1st Name/ Hébreu: Prénom de la mère du mari__________________________ Bat________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
Husband’s MOTHER/ date and place of Birth/ Mère du Mari: date et lieu de naissance:_______/______/______/_____________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
Year
/
Month
/
day
If deceased: Date of death, place where buried, plot Nbr. Some comments._______/______/______/_________________________________
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
Year
/
Month
/
day
____________________________________________________________________________________________________________________
 ____________________________________________________________________________________________________________________
Wife
- Femme
MAIDEN Last name/Nom de famille à la naissance:_________________________________________________________________________
First name/Prénom:_________________________________________Hebrew 1st name/Prénom hébreu______________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
birth date/Date de naissance:_________/____________/_______Time/heure:__________am/pm Day/or/after sundown?/avant ou après le coucher de soleil
Year
/
Month
/
day
Place of birth / Lieu de naissance:_____________________________________________________________________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
If deceased: Date of death, place where buried, plot Nbr. Some comments._______/______/______/_________________________________
Year
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
/
Month
/
day
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Wife’s FATHER 1st & last name / Femme, prénom et nom du père:____________________________________________________________
Wife’s father Hebrew 1st name/Prénom hébreu du père de la femme________________________________Ben________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
Wife’s FATHER/date and place of Birth/ Père de la femme: date et lieu de naissance:_______/______/______/______________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
Year
/
Month
/
day
If deceased: Date of death, place where buried, plot Nbr. Some comments._______/______/______/________________________________
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
Year
/
Month
/
day
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Wife's MOTHER 1st & MAIDEN name/ Mère de la femme: prénom et NOM DE JEUNE FILLE: _____________________________________
Wife’s Mother Hebrew 1st Name/ Hébreu: Prénom de la mère de la femme__________________________ Bat________________________
P l e a s e p r i n t x hps v k t b , ,hr cgc hyrp oa
Wife’s MOTHER/ date and place of Birth/ Mère de la femme: date et lieu de naissance: _______/______/______/____________________________________
G i v e a s m u c h d e t a i l s a s p o s s i b l e l i k e : H o s p i t a l ’s n a m e , c i t y e t c .
Year
/
Month
/
day
If deceased: Date of death, place where buried, plot Nbr. Some comments._______/______/______/________________________________
Si décédé: date du décès, cimetière, numéro de l’emplacement etc. & des commentaires si possible:
Year
/
Month
/
day
____________________________________________________________________________________________________________________
 ___________________________________________________________________________________________________________________
Please fill out only what you can
 Husband’s Side/ Coté du mari:
 Grand Parents on husband’s Father’s side - Grand Parents paternels du coté du père du mari
G.Father’s name:________________________________Hebrew1st________________________G.Father’s date of birth:______ /_____ /_____Place of birth _______________________________
Year
Please prin t xhps v k t b, ,hr cgc hyrp oa
/ Month / day
G.Father’s date of Death:_______ /_______ /______ Place of Death ______________________________Cemetery: ___________________________________Plot number___________________
Year
/
Month /
day
G.Mother’s 1st & MAIDEN name:________________________Hebrew1st __________________G.Mother’s date of birth:______ /_____ /_____Place of birth ________________________________
Year
Please prin t xhps v k t b, ,hr cgc hyrp oa
/ Month / day
G.Mother’s date of Death:_______ /_______ /______ Place of Death _____________________________Cemetery: ____________________________________Plot number__________________
Year
/
Month /
day
 Grand Parents on husband’s Mother’s side - Grand Parents maternels du coté du mari
G.Father’s name:______________________________Hebrew1st______________________G.Father’s date of birth:______ /_____ /_____Place of birth ___________________________________
Please prin t xhps v k t b ,,hr cgc hyrp oa
Year
/ Month / day
G.Father’s date of Death:_______ /_______ /______ Place of Death ______________________________Cemetery: ______________________________________Plot number________________
Year
/
Month /
day
G.Mother’s 1st & MAIDEN name:________________________Hebrew1st __________________G.Mother’s date of birth:______ /_____ /_____Place of birth ________________________________
Please prin t xhps v k t b,,hr cgc hyrp oa
Year
/ Month / day
G.Mother’s date of Death:_______ /_______ /______ Place of Death _____________________________Cemetery: _______________________________________Plot number________________
Year
/
Month /
day
 Wife’s Side / Coté de la femme:
 Grand Parents on Wife’s Father’s side - Grand Parents paternels du coté de la femme
G.Father’s name:_____________________________Hebrew1st______________________G.Father’s date of birth:______ /_____ /_____Place of birth ____________________________________
Please print xhps v k t b, ,hrcgc hyrp oa
Year
/ Month / day
G.Father’s date of Death:_______ /_______ /______ Place of Death ______________________________Cemetery: ________________________________________Plot number______________
Year
/
Month /
day
G.Mother’s 1st & MAIDEN name:________________________Hebrew1st __________________G.Mother’s date of birth:______ /_____ /_____Place of birth ________________________________
Please print x hps v k t b, ,hr cgc hyrp oa
Year
/ Month / day
G.Mother’s date of Death:_______ /_______ /______ Place of Death _____________________________Cemetery: ______________________________________Plot number________________
Year
/
Month /
day
 Grand Parents on Wife’s Mother’s side - Grand Parents maternels du coté de la femme
G.Father’s name:______________________________Hebrew1st______________________G.Father’s date of birth:______ /_____ /_____Place of birth ___________________________________
Please print xhps v k t b ,,hr cgc hyrp oa
Year
/ Month / day
G.Father’s date of Death:_______ /_______ /______ Place of Death ______________________________Cemetery: _______________________________________Plot number_______________
Year
/
Month /
day
G.Mother’s 1st & MAIDEN name:________________________Hebrew1st __________________G.Mother’s date of birth:______ /_____ /_____Place of birth ________________________________
Please print xhps v k t b,,hr cgc hyrp oa
Year
/ Month / day
G.Mother’s date of Death:_______ /_______ /______ Place of Death _____________________________Cemetery: _______________________________________Plot number________________
Year
/
Month /
day
CHILDREN / ENFANTS
First name: _______________________________________________Hebrew 1st name: __________________________________& written in Hebrew____________________________
Birth date:
Year
/
/
Month /
/
P l e a s e p r i n t xhps v k t b, ,hrcgc hyrp oa
day
Time: _____________After sundown? __________ Hebrew date of birth: _____________ /_____________ /_____________
am or pm
Year
/
Month
/
day
Place of birth____________________________________________________________________________________________________________________________________________
Give as much details as possible like: Hospital’s name, city etc.
Married to___________________________________________________________________________________________Lives in:_____________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First name: _______________________________________________Hebrew 1st name: __________________________________& written in Hebrew____________________________
Birth date:
Year
/
/
Month /
/
P l e a s e p r i n t xhps v k t b, ,hrcgc hyrp oa
day
Time: _____________After sundown? __________ Hebrew date of birth: _____________ /_____________ /_____________
am or pm
Year
/
Month
/
day
Place of birth____________________________________________________________________________________________________________________________________________
Give as much details as possible like: Hospital’s name, city etc.
Married to___________________________________________________________________________________________Lives in:_____________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First name: _______________________________________________Hebrew 1st name: __________________________________& written in Hebrew____________________________
Birth date:
Year
/
/
Month /
/
P l e a s e p r i n t xhps v k t b, ,hrcgc hyrp oa
day
Time: _____________After sundown? __________ Hebrew date of birth: _____________ /_____________ /_____________
am or pm
Year
/
Month
/
day
Place of birth____________________________________________________________________________________________________________________________________________
Give as much details as possible like: Hospital’s name, city etc.
Married to___________________________________________________________________________________________Lives in:_____________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First name: _______________________________________________Hebrew 1st name: __________________________________& written in Hebrew____________________________
Birth date:
Year
/
/
Month /
/
P l e a s e p r i n t xhps v k t b, ,hrcgc hyrp oa
day
Time: _____________After sundown? __________ Hebrew date of birth: _____________ /_____________ /_____________
am or pm
Year
/
Month
/
day
Place of birth____________________________________________________________________________________________________________________________________________
Give as much details as possible like: Hospital’s name, city etc.
Married to___________________________________________________________________________________________Lives in:_____________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First name: _______________________________________________Hebrew 1st name: __________________________________& written in Hebrew____________________________
Birth date:
Year
/
/
Month /
/
P l e a s e p r i n t xhps v k t b, ,hrcgc hyrp oa
day
Time: _____________After sundown? __________ Hebrew date of birth: _____________ /_____________ /_____________
am or pm
Year
/
Month
/
day
Place of birth____________________________________________________________________________________________________________________________________________
Give as much details as possible like: Hospital’s name, city etc.
Married to___________________________________________________________________________________________Lives in:_____________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~