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Mechiras Chometz Form
Please verify reCaptcha before submitting the form.
*
Name
*
Email address
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:
*
Address, City, State, Zip
Address, City, State, Zip
Address, City, State, Zip
Please Select from the following Two Options
Please Select One
I will be home for Pesach
I will be away for Pesach
TYPE OF CHOMETZ
Groceries
Liquors
Cereals
Flour
Pasta
EXACT LOCATION
Kitchen
Cabinets
Refrigerator
Freezer
Basement
Cabinets
Refrigerator
Freezer
Living Room
Cabinets
Refrigerator
Freezer
Dining Room
Breakfront
Bathroom
Cabinets
Medicine Cabinets
Sink Bottoms
Bar
Pantry
Garage
Cabinets
Refrigerator
Freezer
Outdoor Grill
Automobile
Business Office
Other
*
Approximate Total Value
I specifically authorize Rabbi Hess to sell the rooms and my chometz located anywhere at the above addresses, with the exception of
*
The keys can be found with:
Name and Address
*
Phone number
What is your Location over Pesach:
*
Signature
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.
*
In witness whereof I have set my hand this (MM/DD/YYYY):
Donation
Total
Tue, July 15 2025 19 Tammuz 5785