FORM FOR THE SALE OF CHAMETZ

It is customary to give a donation to the Rabbi's Discretionary Fund to be disbursed to the poor

for Pesach (Maot Chitim), as well as to provide scholarships for Yeshiva Day Schools. 

Please make checks payable to the Elie Berdugo Chesed Fund.

Your Chametz form will not be finalized or transmitted to the BRS office until you see the confirmation page at the end of the process.

I * do hereby authorize Rabbi Efrem Goldberg, at Boca Raton Synagogue, 7900 Montoya Circle, Boca Raton, Florida to sell, transfer and assign all CHAMETZ of whatever kind and nature, which I own or possess, or in which I may have an interest, wheresoever situated, in the residence(s) stated below to Kerry Purcell:

Address *

City * State * Zip *

Phone # *
or in my place of business,

Address

or in other place(s) , without reservation and limitation.

Please select at least one of the locations below

The location where the chametz can be found in: Kitchen food pantry living room garage
bathroom other places including , , .
The approximate value of such real chametz is $ * Value of Liquor is $ .

If you are going to be away for Pesach:
I specifically authorize Rabbi Goldberg to sell all Chametz located anywhere in my home at the above address, and to lease my entire home (with the exception of the following rooms
)
The keys to my home can be found with:

Name
Address
Phone # Day Evening

If you are going to be in a different time zone, please specify:

If you are in a different timezone, and you have your chametz with you, consider your chametz sold effective when you wake up Erev Pesach and do not consider the chametz bought back or owned by you until the morning after the conclusion of Pesach.

In witness whereof I have set my hand this 10th day of March 2010

Enter an email address if you wish to receive a copy of your contract electronically.

Please enter your full name which will serve as your signature *