Rabbi Ariel Ovadia Minyan Avrechim Sefaradi 500 Marc Drive Lakewood NJ 08701 Arivadia@gmail.com 310-254-7790 Step 1 of 2 50% First Name* Last Name* Best Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address of Premises That Contain Hametz Street Address Address Line 2 Location 1 Location 2 Additional Addresses and Locations of HametzPlease check which hametz items will be included in this sale: Liquor Groceries Perfumes Cosmetics Medications Stocks in chametz Companies Other Location of Keys or number you can be reached at: An Underestimated Approximate Value of Hametz: City that I will be in at the start of Pessah: City that I will be in at the close of Pessah: Other Comments:Please read the following and press Next on the form below to appoint Dayan Dovid Grossman to act as your agent for the selling of your Hametz.* By checking this box and clicking "Next" below as well as “Submit” on the following page I hereby appoint Dayan Dovid Grossman of The Bet HaVaad Halacha Center to act as my official Halachic agent to take all Halachic and legal actions necessary to effectuate the selling of my Hametz. His hand shall be my hand, his voice shall be my voice, his actions shall be my actions.Please read the following and submit the form below to appoint Dayan Dovid Grossman to act as your agent for the selling of your Hametz. I the undersigned, instruct and empower Dayan Dovid Grossman of The Bet HaVaad Halacha Center, to act as my agent to sell all the hametz that I possess. Said Hametz shall include any and all Hametz as defined by the Torah and Rabbinic Law e.g. classic Hametz, questionable Hametz, all kinds of Hametz mixtures, Hametz that tends to affix itself to surfaces of pans, pots, or cooking utensils, as well as pet food that contain Hametz or Hametz mixtures. This shall include all Hametz that I am aware of as well as hHametz that I am not aware of. (herein “Hametz”) In addition, I hereby instruct and empower Dayan Dovid Grossman, to lease all places wherein any forms of Hametz may be found, particularly at the address/es listed herein, and elsewhere anywhere in the world. In addition, I hereby give Dayan Dovid Grossman the full right and power to appoint any agent, substitute, or designee in his stead (herein the "Attending Rabbi"). Said Attending Rabbi shall have full right to sell and lease as provided herein. In addition, I hereby appoint and empower the abovementioned Attending Rabbi as my direct agent to act on my behalf as specified herein. The Attending Rabbi has the full power and right to act as he deems fit and proper in accordance with all the details of the Bill of Sale used in the transaction to sell all my Hametz, as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws. Wherever possible it is ideal to effectuate the above process using a valid Kinyan. Please call the Bet HaVaad office to finalize the process. Bet Havaad will attempt to contact you at the above phone number as well. Should a personal connection not be made, this form will suffice to effectuate the process. Bet HaVaad wishes you a Hag Kasher V'Sameah!! Mechiras Hametz Acknowledgement for Rabbi Ovadia: Maot Hittim Donation:Please distribute:Full Yom Tov Stipend: ($250.00)Matza for an entire family: ($150.00)Wine for an entire family: ($100.00)OtherEnter Maot Hittim Amount (per needy family)* Please distribute the above Maot Hittim amount to the following number of needy families12345678910Maot Hittim AmountPlease distribute the above total Maot Hittim amount on behalf of myself as well as on behalf ofAdditional members of my familyMaot Hittim Subtotal Price: $0.00 Maot Hittim Subtotal Price: $0.00 Formula Price: $0.00 Formula Amount Price: $0.00 Total donation to be processed: $0.00 Please distribute to families in:The USAEretz YisroelNo PreferenceName First Last Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Total donation to be processed: $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name