BUSINESS NAME

Address Line 1
Address Line 2
Phone
Email LOGO
City, State, Zip Web

Employee Name CURRENT EARNINGS

Employee Number EARNING TYPE HOURS PYMNT

Federal Filing Status Regular Pay 0.00 $ -

Pay Begin Date Overtime 0.00 $ -

Pay End Date Leave Hours 0.00 $ -

Tax Allowance TOTALS 0.00 $ -

LEAVE BENEFITS SUMMARY

LEAVE TYPE BEGINNING BALANCE ACCRUED TAKEN BALANCE

Holidays 0.00 0.00 0.00 0.00

Vacation 0.00 0.00 0.00 0.00

Sick Time 0.00 0.00 0.00 0.00

Comp Time 0.00 0.00 0.00 0.00

Other 0.00 0.00 0.00 0.00

Other 0.00 0.00 0.00 0.00

STATEMENT SUMMARY

EARNINGS TYPE CURRENT YTD EARNINGS TYPE CURRENT YTD

Taxable Gross $ - $ - Deductions $ - $ -

Non-Taxable Gross $ - $ - Net Pay $ - $ -

Previous Gross Pay $ - $ - Excess Life $ - $ -

Gross Pay $ - $ - Other $ - $ -

Other $ - $ - Other $ - $ -

DEDUCTION TYPE NOTES CURRENT YTD

Federal Withholding Tax $ - $ -

State Withholding Tax $ - $ -

FICA-Medicare $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

Other $ - $ -

TOTALS $ - $ -
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