Please submit this form by Thursday, April 18th:

I, the undersigned, fully empower and permit Rabbi Yosef Carlebach to act in my place and stead, and on my behalf to sell all Chametz possessed by me, knowingly or unknowingly as defined by the Torah and Rabbinic Law (e.g. Chametz, possible Chametz, and all kinds of Chametz mixtures).

Also, Chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating Chametz and mixtures thereof.

Rabbi Carlebach is also empowered to lease all places wherein the Chametz owned by me may be found, particularly at the address/es listed below, and elsewhere.

Rabbi Carlebach has full right to appoint any agent or substitute in his stead and said substitute shall have full right to sell and lease as provided herein.

Rabbi Carlebach also has the full power and right to act as he deems fit and proper in accordance with all the details of the Bill of Sale used in the transaction to sell all my Chametz, Chametz mixtures, etc., as provided herein.

This power is in conformity with all Torah, Rabbinic and Civil laws.