CO. FILE DEPT.
CLOCK NUMBER
ABC 126543 123456 12345 00000000
1 Earnings Statement
ARIOHN RESTORATIONS LLC Period ending: 7/18/2008
1792 S. 15TH STREET STE 201 Pay date: 7/25/2008
OZARK, MO 65721
Social Security Number: ***-**-0804 JOHN T.
Taxable Marital Status: Married
Exemptions/Allowances: PO BOX 1065
Federal: 3, $25 Additional OZARK, MO 65721
Tax State: 2
Local: 2
Earnings rate hours this period year to
Regular 10.00 32.00 date Other Benefits and
Overtime 15.00 1.00 320.00 16,640.00
Information this period total to
Holiday 10.00 8.00 15.00 780.00 date
Group Term
Tuition 80.00 4,160.00 0.51 27.00
Life Loan Amt
Gross $ 452.43
37.43* 1,946.80 840.00
Pay 23546.78
Vac Hrs 40.00
Deductions Statutory
Federal Income Tax - 2,111.20 Sick 16.00
Social Security Tax 40.60 1,458.60 Hrs Operator
Medicare Tax - 341.12
NY State Income 28.05 438.36
Tax NYC Income - 6.56 308.88 Important Notes
Tax - 8.43 31.20 EFFECTIVE THIS PAY PERIOD YOUR REGULAR
NY SUI/SDI Tax - 5.94 HOURLY RATE HAS BEEN CHANGED FROM $8.00
- 0.60 TO $10.00 PER HOUR.
Other
©2008, 2001, 2000, 1999 ADP,
Bond - 5.00 100.00 WE WILL BE STARTING OUR UNITED WAY FUND
401(k) - 28.85* 1,500.20 DRIVE SOON AND LOOK FORWARD TO YOUR
Stock Plan -15.00 150.00 PARTICIPATION.
Life Insurance - 5.00 50.00
Loan - 30.00 150.00
Adjustment
Inc.
Life Insurance + 13.50
Net $ 291.90
Pay
* Excluded from federal taxable wages
TEAR
Your federal wages this period are $386.15
▲
ACME SUPPLIES CORP. Payroll check number: 0000000000
475 KNAPP AVENUE Pay date: 7/25/2008
ANYTOWN, USA 10101 Social Security No. 999-99-9999
Pay to the
order of: JANE HARPER
This amount: TWO HUNDRED NINETY-ONE AND 90/100 DOLLARS $291.90
BANK NAME
STREET ADDRESS
CITY STATE ZIP
SAMPLE
NON-NEGOTIABLE
VOID VOID VOID SAMPLE AUTHORIZED SIGNATURE
VOID AFTER 90 DAYS
½001379½ 122000496 4040110157½
THE ORIGINAL DOCUMENT HAS A REFLECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENT.