| cemetery | Warszawa (Okopowa) |
| sector | 58 |
| row | 21 |
| number | 31 |
| sex | M |
| surname | Goldberg |
| first name | |
| hebrew name | Chaim Shmuel |
| fathers name | Kalonimos |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | 2/16/1930 |
| additional info | żył lat 37, z: Końskowola |
