Hametz Agreement 2023

Mekhirat Hametz Agreement

Pesach 5783/2023

Please complete this Mekhirat Hametz Agreement form no later than 11:00 AM on Wednesday, April 5th.

Click HERE for a fillable PDF version.

* First Name

* Last Name

* Email

Address Line 1

Address Line 2

City

State

Zip Code

Do You Have An Additional Address Where Hametz Might Be Found?

Address Line 1

Address Line 2

City

State

Zip Code

* I hereby designate Rabbi Adam J. Raskin to act on my behalf in selling the hametz in my possession. I understand that hametz will return to my possession after 8:26 PM on Thursday, April 13th.

I hereby designate Rabbi Adam J. Raskin to act on my behalf in selling the hametz in my possession. I understand that hametz will return to my possession after 8:26 PM on Thursday, April 13th.

* Electronic Signature

* Date

Donation to the Rabbi’s Discretionary Fund (enter amount)

Fri, April 25 2025 27 Nisan 5785

Congregation Har Shalom
11510 Falls Road | Potomac, MD 20854
Tel.: 301-299-7087 | Fax: 301-299-2247

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