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SALE OF CHOMETZ - Authorization Form

I fully empower and authorize Rabbi Dale Polakoff and/or Rabbi Ian Lichter of the Great Neck Synagogue to dispose
of all Chometz that may be in my possession, or whose owners have authorized me to make such arrangements,
wherever it may be, at home, place of business or elsewhere (knowingly or unknowingly). Rabbi Polakoff and/or
Rabbi Lichter have full right to sell, dispose, conduct all transactions as they deem fit and proper for such time
which they believe necessary, in accordance with the detailed hebrew contracts which are in their possession.

The above power hereby given is meant to conform with all Torah and Rabbinic regulations, to meet the
requirements of Jewish law and to concur with the laws of the State of New York.

Most of the above mentioned Chometz is located at:

(address) (specific location at address - ie, kitchen, etc.) (approximate value)

1. ____________________________________ _________________________________________________ _______________

2. ___________________________________ ________________________________________________ _______________

3. ___________________________________ ________________________________________________ _______________

4. ___________________________________ ________________________________________________ _______________

To all of the above, I affix my signature.

Signed __________________________________________________________________ Date __________________________

Print Name ______________________________________________________________

IF YOU WILL NOT BE IN GREAT NECK and will be in a different time zone for either the beginning or the end of
Pesach, please fill out the following:

For the beginning of Pesach, I will be in: For the end of Pesach, I will be in:

_______________________________________________________ ________________________________________________________

This form must be emailed to greatnecksynagogue@gmail.com or faxed to 516-487-6149 by
Friday, April 15, 2022 by 9:00 a.m. Arrangements for the sale of chometz can also be made
at https://www.gns.org/chometz-sale-2022/.

SCOPE Magazine Passover 2022 64