| cemetery | Otwock |
| sector | |
| row | 11 |
| number | 19 |
| sex | M |
| surname | Gotlieb |
| first name | |
| hebrew name | Yaakov Shimon |
| fathers name | Yosef |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | 1/17/1925 |
| additional info | z Warszawy, żył 50 lat |
