Please print this form, fill it out and mail it to:
2233 West Mequon Rd, Mequon WI 53092
Fax it ASAP to (262) 242 9516)

DELEGATION OF POWER
FOR SALE OF CHOMETZ

KNOW YE that I, the undersigned, fully empower and permit Rabbi Rapoport  to act in my place and stead, and my behalf to sell all the Chometz possessed to me (knowingly or unknowingly) as defined by the Torah and Rabbinic Law (e.g. Chometz, possible Chometz, and all kinds of Chometz mixtures.) Also Chometz that tends to harden and to adhere to inside surfaces of pans, pots or cooking and usable utensils.  And to lease all places wherein the Chometz owned by me may be found, especially in the premises located at

_______________________________________ and elsewhere.

Rabbi Rapoport has the full right to sell and to lease by transactions as he deems fit and proper and for such time which he believes necessary in accordance with all detailed terms and detailed forms as explained in the general authorization contracts which have been given this year to Rabbi Rapoport full power and authority to appoint a substitute in his stead with full power to sell and to lease as provided therein.  The above given power is in conformity with all Torah and Rabbinical regulations and laws, and also in accordance with laws of the State of Wisconsin and of the United States.

Please print:

Name ___________________________________________

Address __________________________________________

City/State/Zip______________________________________

Business Address________________________________

DATE __________________.

Signature___________________________________