| cemetery | Warszawa (Okopowa) |
| sector | 75 |
| row | 11 |
| number | 9 |
| sex | M |
| surname | Polak |
| first name | |
| hebrew name | Mordechai Shimon |
| fathers name | Yitzhak |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | 10/21/1912 |
| additional info | żył lat 60 |
