CERTIFICATE AUTHORIZING THE SALE OF CHAMETZ 5781

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Please submit this form no later than Thursday, March 25^th, 2021 at 8 AM.

All required fields must be answered in order to submit the form

MEMBERS: log into your account first and some fields will be filled in for you automatically.

AUTHORIZATION OF RABBI PERELSON

* Please check this box to confirm the following statement:

Please check this box to confirm the following statement:

I/we hereby authorize Rabbi Yisroel Perelson to dispose of all chametz that may be in my (our) possession; wherever it may be - at home, at my (our) place of business, or elsewhere - accordance with the requirements of Jewish Law as incorporated in the special contract for the sale of chametz.

HEAD OF HOUSEHOLD

* Last Name

* First Name

* e-mail address

RESIDENCE ADDRESS WITH CHAMETZ

* Residence Address Line 1

Residence Address Line 2

* City

* State

* Zip

BUSINESS AND OTHER ADDRESSES WITH CHAMETZ

Use the + button to enter as many business/other addresses as you need.

Business/Other Street Address

Business/Other City/State/Zip

HONORARIUM

Please consider an honorarium for Rabbi Perelson for acting as your agent in the sale of your Chametz.

Honorarium $

ELECTRONIC SIGNATURE

* Your Signature(s)

Head of household, and preferably all parties, sign with initials.

Fri, April 26 2024 18 Nisan 5784

CERTIFICATE AUTHORIZING THE SALE OF CHAMETZ 5781

Please submit this form no later than Thursday, March 25th, 2021 at 8 AM.

Please submit this form no later than Thursday, March 25^th, 2021 at 8 AM.