B”SD
PLEASE COPY & PASTE FORM ONTO EMAIL
or COPY & PRINT TO BRING TO THE RABBI
CERTIFICATE AUTHORIZING THE
SALE OF CHOMETZ
Please return this form early, as responsibility cannot be accepted for forms received after
Wednesday, March 29th, 2010 at 7:00 a.m.
**I / WE, ________________________________________________________________
(PLEASE PRINT)
Hereby authorize Rabbi Zalman Gansburg to dispose of all Chometz that may be in my (our) possession wherever it may be – at home, at my (our) place of business, or elsewhere – in accordance with the requirements of Jewish law as incorporated in the special contract for the sale of Chometz.
Residence address: _______________________________________________________
Apt. # _________
City: ________________________________
State: ______ Zip ___________
Telephone # ____________________________________
*** Area where Chometz and utensils are stored: __________________________________________
Business address: ________________________________________________
Suite # ________
City: _________________________________
State: ______ Zip ___________
*** Area where Chometz and utensils are stored: __________________________________________
*Signature (s)
______________________________________ Date ______________________
______________________________________ Date ______________________
*Must be signed by head of household and preferably by all parties
** Husband and wife, specify names
*** Use separate sheet or back of this sheet if you need more space
Chabad of Palmetto Bay
16721 SW 78th Ct, Palmetto Bay, FL 33157
786-282-0413
www.jewishpalmettobay.org
