Rabbi Chaim Boruch Rubin 303 South Highland Ave Los Angeles, CA 90036 323-240-0800 Step 1 of 2 50% First Name*Last Name*Best Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address of Premises That Contain Chametz Street Address Address Line 2 Location 1Location 2Additional Addresses and Locations of ChametzPlease check which chametz 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 Chametz:City that I will be in at the start of Pesach:City that I will be in at the close of Pesach:Other Comments:Please read the following and press Next on the form below to appoint Harav Dovid Grossman to act as your agent for the selling of your Chametz.* By checking this box and clicking "Next" below as well as “Submit” on the following page I hereby appoint Rav Dovid Grossman of The Bais HaVaad Halacha Center to act as my official Halachic agent to take all Halachic and legal actions necessary to effectuate the selling of my chametz. His hand shall be my hand, his voice shall be my voice, his actions shall be my actions. Show Full AgreementPlease read the following and submit the form below to appoint Harav Dovid Grossman to act as your agent for the selling of your Chametz. I the undersigned, instruct and empower Harav Dovid Grossman of The Bais HaVaad Halacha Center, to act as my agent to sell all the chametz that I possess. Said chametz shall include any and all chametz as defined by the Torah and Rabbinic Law e.g. classic chametz, questionable chametz, all kinds of chametz mixtures, chametz that tends to affix itself to surfaces of pans, pots, or cooking utensils, as well as pet food that contain chametz or chametz mixtures. This shall include all chametz that I am aware of as well as chametz that I am not aware of. (herein “chametz”) In addition, I hereby instruct and empower Harav Dovid Grossman, to lease all places wherein any forms of chametz may be found, particularly at the address/es listed herein, and elsewhere anywhere in the world. In addition, I hereby give Harav 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 chametz, 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 Bais HaVaad office to finalize the process. Bais 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. Bais HaVaad wishes you a Chag Kasher V'Sameach!! Mechiras Chametz Appreciation Gift for Rabbi Rubin: Maos Chittim Donation:Please distribute:Full Yom Tov Stipend: ($250.00)Matza for an entire family: ($150.00)Wine for an entire family: ($100.00)OtherEnter Maos Chittim Amount (per needy family)* Please distribute the above Maos Chittim amount to the following number of needy families12345678910Maos Chittim AmountPlease distribute the above total Maos Chittim amount on behalf of myself as well as on behalf ofAdditional members of my familyMaos Chitim Subtotal Price: $0.00 Maos Chitim 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Total donation to be processed: $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name