Bereavement Notice Request

Please complete this form if you would like CBH to send out a death notice to the congregation. To get in touch with the Rabbi please email rabbibriskin@bethaverim.org or call (530) 758-0842.

CBH Bereavement Notice Request Form

Complete this form to request that a bereavement notice be sent out to the congregation.

Your name*
First Last
Your email address (we will send a draft notice to this address for approval)*
Your phone number*
Name of decedent*
First Last
The decedent is my*

Spouse, parent, friend, etc.
Date of death*
Time of death*

: Hours

Minutes

AM/PM
Location of death*
Names of family and/or friends you would like listed in the notice*
Surviving family members, friends, etc.
Biographical information you would like to include*
Ex. Short biography, a summary of the person’s life, surviving family members, etc.
Donations in memory can be made to:

Please enter the name of the organization(s) and website link if applicable.
Would you like to include a photo of the decedent?
Drop files here or

Max. file size: 22 MB.
Please attach a jpg file if you would like to include a photo.
Funeral information*
Shiva information*
Would you like to observe the Yahrzeit on the Hebrew calendar (ie: 1 Tishrei) or the Gregorian calendar (ie: January 1)*
- Hebrew Observance
- Gregorian Observance

Bereavement Notice Request

CBH Bereavement Notice Request Form

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