I hereby authorize Rabbi Eric M. Solomon of Beth Meyer Synagogue to become legally responsible for the hametz in my possession. He is hereby permitted to sell my hametz to another agent on my behalf. I understand that I am not permitted to benefit from the above-mentioned hametz during Pesah. I will give a contribution to the synagogue in order to buy back this hametz.

Home - please provide complete address including apartment # (if appropriate) and city, state, and zip.

i.e., office, residence, vacation home, etc. - please provide complete address including apartment # (if appropriate) and city, state, and zip.