Please print the attached and fill it out - and drop in the shul mail slot or at the Rabbi's home mail slot or with him, to sell your Chametz for Pesach (printed forms are also available at the shul)

[OrMenorah Congregation]

DELEGATION OF POWER FOR SALE OF CHAMETZ 5786

I, THE UNDERSIGNED, EMPOWER AND PERMIT Rabbi Doug (Dov) Zelden to act in my place and stead, as my agent, to sell all chametz (Leaven) and all products containing even the smallest percentage of chametz possessed by me as defined by the Torah and Rabbinic law, and to lease all designated places wherein the above mentioned products may be found, beginning erev Pesach, 5786, especially in the premises located at: 

________________________                        __________________________________

Family Name                                                  Full home address

________________________                        __________________________________

Name of Firm/Company                                 Full business address

Rabbi Zelden has the full right as my agent to sell or appoint an agent on his behalf to sell and to lease the above by such transactions as he deems fit and proper for such time as he chooses. The authority, which is hereby given, is meant to be in conformity with the Torah and Rabbinic laws and regulations, and also be in acceptance with the law of the State of Illinois and the United States of America.

To this I do hereby affix my signature on this date: March________, 2026

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                                                                        Signature

Please print:
______________________________

Name
_______________________________

Address
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City/State/Zip
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Area Code & Phone
_______________________________

Email Address: 

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