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  1.                                                                                                                                                                                   ST. JOSEPH'S REHABILITATION CENTER, INC.    ┌─────────────┐                                CHECK REQUISITION               │Period:░░░░░░│                                                                └─────────────┘┌─────────────────┐      ┌────────────────────────┐      ┌────────────────────┐│ Date:   /   /   │      │ Date Needed:   /   /   │      │ Vendor #:          │└─────────────────┘      └────────────────────────┘      └────────────────────┘┌─────────────────────────────────────────────────────────────────────────────┐│ Vendor:                                                                     │├─────────────────────────────────────────────────────────────────────────────┤│ Address:                                                                    │├──────────────────────────────────────────────────┬────────────┬─────────────┤│ City:                                            │ State:     │ Zip:        │└──────────────────────────────────────────────────┴────────────┴─────────────┘                                                                                                                                                                Description                        Dept             Account       Amount     ┌─────────────────────────────────┬─────────────────┬─────────────┬───────────┐│                                 │  01-    -       │             │       .   │├─────────────────────────────────┼─────────────────┼─────────────┼───────────┤│                                 │  01-    -       │             │       .   │├─────────────────────────────────┼─────────────────┼─────────────┼───────────┤│                                 │  01-    -       │             │       .   │├─────────────────────────────────┼─────────────────┼─────────────┼───────────┤│                                 │  01-    -       │             │       .   │└─────────────────────────────────┼─────────────────┴─────────────┼───────────┤                                  │  TOTAL TO PAY                 │       .   │                                  └───────────────────────────────┴───────────┘                                                                               Special Instructions:                                                          ┌─────────────────────────────────────────────────────────────────────────────┐│                                                                             │├─────────────────────────────────────────────────────────────────────────────┤│                                                                             │├─────────────────────────────────────────────────────────────────────────────┤│                                                                             │└─────────────────────────────────────────────────────────────────────────────┘                                                                                                                 Requested by:                    Date:                                        ┌───────────────────────────────┬────────────┐                                 │                               │    /   /   │                                 └───────────────────────────────┴────────────┘                                  Approved by:                     Date:                                        ┌───────────────────────────────┬────────────┐                                 │                               │    /   /   │                                 └───────────────────────────────┴────────────┘                                                                                Date Entered:  By:               Date Paid:      By:              Check #:    ┌──────────────┬──────────┐      ┌──────────────┬────────────────┬────────────┐│    /    /    │          │      │    /    /    │                │            │└──────────────┴──────────┘      └──────────────┴────────────────┴────────────┘                                                                                                                                                              Please note:  If copies of this form or any attachements are required for                    your files, please make them before submitting for payment.                    Allow 7 days from date of request to date needed!                                                                                               chkreq.frm                                                                     10/5/89