
I the undersigned, fully empower and permit Rabbi Mendy Gurkov to act in my place and stead, and in my behalf to sell all Chometz possessed by me (knowingly or unknowingly) as defined by the Torah and Rabbinical law (e.g. Chometz, possible Chometz, and all kinds of Chometz mixtures and Chometz which adheres to utensils.) Rabbi Mendy Gurkov shall lease all places wherein the Chometz is owned by me and/or may be found, in the premises in locations listed below.
Form must be received on or before Thursday, April 9, 2017.
| Please enter your personal information. Use the address in which the Chametz is located. Please list all addresses where your property is owned. | |
| First Name |
Last Name |
| Address |
City |
| State |
Zip Code |
| Phone |
Email |
| Additional Information |
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| Card Number |
Expiration |
| CVV Code |
Donation Amount |
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Terms of agreement |
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Rabbi Mendy Gurkov has the full right to sell and to lease by transactions, as he deems fit and proper and for such time which he believes necessary in accordance with all details delineated in the authorization contract of this year 5777/2017 which is to be used by Rabbi Gurkov to sell the Chometz. |
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I Agree to the above terms |
