Mechiras Chametz form

Delegation of Power to Sell Chometz

I the undersigned, fully empower and permit Rabbi Ephraim Simon 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 kind of chametz mixtures). Also chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, as well as pet food that contain chametz and mixtures thereof. Rabbi Ephraim Simon 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 Ephraim Simon 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 Ephraim Simon 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

If you have more than one address, please submit the form one time for each address. 

There is a custom to make a donation in connection with the sale of chametz to help pay for the costs of the sale. This is voluntary but very appreciated!