| cemetery | Warszawa (Okopowa) |
| sector | 58 |
| row | 8 |
| number | 30 |
| sex | M |
| surname | B...n |
| first name | |
| hebrew name | Yaakov Chaim |
| fathers name | Dov Ber Hakohen |
| husbands name | |
| maiden name | |
| date of birth (m/d/y) (m/d/r) | |
| date of death (m/d/y) (m/d/r) | |
| additional info | zm. 5664 r. |
