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Mechiras Chometz Form

I, the undersigned, fully empower and permit Rabbi Joshua Hess to act on my behalf to sell all forms of chometz (leaven) possessed by me knowingly or unknowingly, as defined by Torah and Rabbinic law, and to lease all places in which chometz owned by me may be found, especially at the following addresses:
Please Select from the following Two Options
EXACT LOCATION
Name and Address
This contract may be filled out on the Anshe Chesed Website by and submitted this form to the Synagogue Office before 5:00 pm EST on Tuesday, April 7, 2020. If you do not receive an email confirmation regarding your submission, please contact the Synagogue office.
Mon, April 6 2020 12 Nisan 5780