| cemetery | Mińsk Mazowiecki |
| sector | mmz |
| row | 5 |
| number | 8 |
| sex | F |
| surname | Polak |
| first name | |
| hebrew name | ... |
| fathers name | Tzvi Yaakov |
| husbands name | Yitzhak Moshe |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | |
| additional info | ojciec z Grodna |
