| cemetery | Warszawa (Okopowa) |
| sector | 47 |
| row | 9 |
| number | 22 |
| sex | M |
| surname | Goldberg |
| first name | |
| hebrew name | Shmuel Avraham Peretz |
| fathers name | Yaakov Tuvia |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | 3/22/1923 |
| additional info | z Suwałk, żył 55 lat |
