CONGREGATION EZRA BESSAROTH
SEATTLE, WASHINGTON

AUTHORIZATION OF AGENT TO SELL HAMETZ
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Name(s) ___________________________________________________
Address (Home) _____________________________________________
Address (Business)____________________________________________

I/we, (NAMES) __________________________________________________

hereby authorize Rabbi Salomon Cohen-Scali to act as my/our agent to sell in my/our name(s) and on
my/our behalf, all hametz owned and possessed by me/us, knowingly or unknowingly, wherever it may be
– at home, place of business, or elsewhere; and all kinds of live animals that have been eating hametz or
mixtures of  thereof, and to lease all places wherein the hametz owned by me/us may be found, especially
located in the premises as listed above – all in accordance with the requirements and provisions of Jewish
law.

I/we, hereby affix my/our signature(s) on this ____day of____________, 2006.

__________________________         __________________________
(Signature)                                            (Signature)


PLEASE RETURN THIS FORM TO THE SYNAGOGUE OFFICE
NO LATER THAN MONDAY, APRIL 10, 2006.

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I am enclosing $___________ for the Maot Hittim fund (Checks  made payable to Ezra Bessaroth).  It is
a mitzvah to make a voluntary donation for Maot Hittim, money that will enable needy Jews to
purchase Passover foods.