| cemetery | Warszawa (Okopowa) |
| sector | 45 |
| row | 33 |
| number | 4 |
| sex | M |
| surname | Balsam |
| first name | |
| hebrew name | Dov Ber |
| fathers name | Mordechai Zeev |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | 4/2/1907 |
| additional info | z Warszawy |
