126543 123456 12345
DEPT.
CLOCK
00000000
Earnings Statement
1
ACME SUPPLIES CORP.
475 KNAPP AVENUE
ANYTOWN, USA 10101
Period ending:
Pay date:
Social Security Number: 999-99-9999
Taxable Marital Status: Married
Exemptions/Allowances:
Federal: 3, $25 Additional Tax
State:
2
Local:
2
JANE HARPER
101 MAIN STREET
ANYTOWN, USA 12345
rate
10.00
15.00
10.00
hours
32.00
1.00
8.00
Gross Pay
Deductions
NUMBER
this period
320.00
15.00
80.00
37.43*
$ 452.43
Statutory
Federal Income Tax
Social Security Tax
Medicare Tax
NY State Income Tax
NYC Income Tax
NY SUI/SDI Tax
- 40.60
- 28.05
- 6.56
- 8.43
- 5.94
- 0.60
2,111.20
1,458.60
341.12
438.36
308.88
31.20
Other
Bond
401(k)
Stock Plan
Life Insurance
Loan
- 5.00
- 28.85*
-15.00
- 5.00
- 30.00
100.00
1,500.20
150.00
50.00
150.00
Adjustment
Life Insurance
+ 13.50
Net Pay
Other Benefits and
Information
year to date
16,640.00
780.00
4,160.00
1,946.80
23,526.80
Group Term Life
Loan Amt Paid
Vac Hrs
Sick Hrs
Title
7/ 18 /2008
7/25/2008
this period
0.51
total to date
27.00
840.00
40.00
16.00
Operator
Important Notes
EFFECTIVE THIS PAY PERIOD YOUR REGULAR
HOURLY RATE HAS BEEN CHANGED FROM $8.00
TO $10.00 PER HOUR.
©2008, 2001, 2000, 1999 ADP, Inc.
Regular
Overtime
Holiday
Tuition
FILE
WE WILL BE STARTING OUR UNITED WAY FUND
DRIVE SOON AND LOOK FORWARD TO YOUR
PARTICIPATION.
$ 291.90
TEAR HERE
Earnings
CO.
ABC
* Excluded from federal taxable wages
Your federal wages this period are $386.15
▲
32728310E
Payroll check number:
Pay date:
Social Security No.
ACME SUPPLIES CORP.
475 KNAPP AVENUE
ANYTOWN, USA 10101
E
L
P
M
A
S
Pay to the
order of:
JANE HARPER
This amount:
TWO HUNDRED NINETY-ONE AND 90/100 DOLLARS
BANK NAME
STREET ADDRESS
CITY STATE ZIP
SAMPLE
NON-NEGOTIABLE
VOID VOID VOID
0000000000
7/25/2008
999-99-9999
$291.90
AUTHORIZED SIGNATURE
VOID AFTER 90 DAYS
001379 1220004964040110157
THE ORIGINAL DOCUMENT HAS A REFLECTIVE WATERMARK ON THE BACK.
HOLD AT AN ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENT.