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CO. FILE DEPT. CLOCK VCHR.NO 062
Company Name
Compnay Number
Company Street Address 1
Company Street Address 2
City,State Zip
Taxable Marital Status:
Exemptions/allowances:
Employee ID:
single
0
Earnings Statement
Period Beginning:
Period Ending:
Pay Date:
Employee Name
Employee Telephone
Employee Street Address 1
Employee Street Address 2
City,State Zip
Earnings Rate Hours Amount Year To Date
Regular 0.00 0.00 0.00 0.00
Salary 0.00 0.00 0.00 0.00
Contract 0.00 0.00 0.00 0.00
Overtime 0.00 0.00 0.00 0.00
Holiday 0.00 0.00 0.00 0.00
Vacation 0.00 0.00 0.00 0.00
Bonus 0.00 0.00 0.00 0.00
Tips 0.00 0.00 0.00 0.00
Gross Pay
 
Deduction Statutory
FICA - Medicare -
FICA - Social Security -
Federal Tax -
State Tax -
SDI -
SUI -
WC -
FLI -
Workforce Development -
Other
Net Pay $
Check - $900.00
Net Check $0.00
Other Benefits and Information This Period Year To Date
not check
Company Name
Compnay Number
Company Street Address 1
Company Street Address 2
Company City,State Zip
Advice Number:
0000018317
Pay Date:
Pay to the order of EMPLOYEE NAME
This amount THREE HUNDREDSIXTY TWO AND 57/100 DOLLARS $600.00
Deposited to the account of Account Number Transit ABA Amount
EMPLOYEE NAME xxx- xxxx xxx $600.00
NON-NEGOTIABLE
Company Name
4654445544
Company Street Address 1
Company Street Address 2
City, State Zip
Advice Number:
0000018317
Pay date:
09/29/2022
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Pay to the order of Amount
EMPLOYEE NAME $600.00
Deposited to the account of Account Number Transit ABA Amount
EMPLOYEE NAME xxx- xxxx xxx $600.00
NON-NEGOTIABLE
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Employee Name Employee Address Company Name Company Address Pay Period Begin Pay Period End Check Date
Employee name
Employee Telephone
Employee street address 1
Employee Street Address 2
City, State Zip
Company Name
4654445544
Company street address 1
Company Street Address 2
city,State Zip
09/15/2022 10/14/2022 10/15/2022
Important Notes
The Meal and Rest Break Policy provides you with the opportunity to take meal and rest breaks. As provided in the Meal and Rest Break Policy, requirements vary by state. If you believe that you have been denied the opportunity to take the meal and rest breaks during your scheduled shift under the Meal and Rest Break Policy, promptly notify payroll.

Please review the hours worked and pay in this paycheck and earnings statement, if you believe that there are any errors, promptly notify Payroll.
Gross Pay Pre Tax Deductions Taxes Post Tax Deductions Net Pay
Current 6320.00 0.00 1693.46 0.00 4626.54
YTD 63200.00 0.00 16934.60 0.00 46265.40
Earnings
Description Rate Hours Amount YTD
Regular
Salary
Contract
Overtime
Holiday
Vacation
Bonus
Tips
Associate Taxes
Description Amount YTD
FICA - Medicare 0.00 0.00
FICA - Social Security 0.00 0.00
Federal Tax 0.00 0.00
State Tax 0.00 0.00
SDI 0.00 0.00
SUI 0.00 0.00
WC 0.00 0.00
FLI 0.00 0.00
Workforce Development 0.00 0.00
Earnings 0.00 46265.40
Associate Taxes 0.00 0.00
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Company Name
4654445544
Company Street Address 1
Company Street Address 2
City,State Zip

EARNINGS STATEMENT
EMPLOYEE NAME/ ADDRESS EMPLOYEE NO. REPORTING PERIOD PAY DATE
EMPLOYEE NAME
Employee Telephone
Employee Street Address 1
Employee Street Address 2
City, State Zip
 856 09/20/2022 - 10/19/2022 10/20/2022
INCOME RATE HOURS CURRENT PAY
Regular $0.00 0.00 $0.00
Salary $0.00 0.00 $0.00
Contract $0.00 0.00 $0.00
Overtime $0.00 0.00 $0.00
Holiday $0.00 0.00 $0.00
Vacations $0.00 0.00 $0.00
Bonus $0.00 0.00 $0.00
Tips $0.00 0.00 $0.00
DEDUCTION TOTAL YTD TOTAL
STATUTORY DEDUCTIONS
FICA - Medicare $ $
FICA - Social Security $ $
Federal Tax $ $
State Tax $ $
SDI $ $
SUI $ $
WC $ $
FLI $ $
Workforce Development $ $
YTD GROSS YTD DEDUCTION YTD NET PAY
$400.00 $400.00 $4369.00
TOTAL DEDUCTION NET PAY
$434.0 $45.00 $600.0
Deposited to the account of Account Number Transit ABA Amount
EMPLOYEE NAME xxx- xxxx xxx $600.00
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EARNINGS STATEMENT
COMPANY NAME COMPANY ADDRESS
COMPANY NAME Company Street Address 1, Company Street Address 2, City, State Zip
4654445544
EMPLOYEE NAME MARITAL STATUS EMPLOYEE NO.
EMPLOYEE NAME single
PAY DATE PAY PERIOD PAY MODE PAY TYPE EXEMPTIONS
10/20/2022 09/20/2022-10/19/2022 Monthly Hourly 0
INCOME RATE HOURS CURRENT TOTAL
Regular 10.00 40.00 400.00
Salary 40.00 400.00
Contract 40.00 400.00
Overtime 10.00 40.00 400.00
Holiday 10.00 40.00 400.00
Vacation 10.00 40.00 400.00
Bonus 10.00 40.00 400.00
Tips 10.00 40.00 400.00
DEDUCTIONS CURRENT TOTAL YTD TOTAL
FICA - Medicare 10.00 40.00
FICA - Social Security 10.00 40.00
FEDERAL TAX 10.00 40.00
STATE TAX 10.00 40.00
SDI 10.00 40.00
SUI 10.00 40.00
WC 10.00 40.00
FLI 10.00 40.00
Workforce Development 10.00 40.00
YTD GROSS YTD DEDUCTIONS YTD NET PAY TOTAL DEDUCTIONS NET PAY
4000.00 374.33 3625.62 400.00 37.43 362.57
Deposited to the account of Account Number Transit ABA Amount
EMPLOYEE NAME xxx- xxxx xxx $600.00
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Company Name
4654445544
Company Street Address 1
Company Street Address 2
City, State Zip
Pay Three Hundred Sixty Two And 57/100 Dollars $362.57
This is not a check
Pay to the order of
EMPLOYEE NAME
Employee Telephone
Employee Street Address 1
Employee Street Address 2
City, State Zip
Company Name
4654445544
Company Street Address 1
Company Street Address 2
City, State Zip

Earnings Statement
Employee Information Employee ID Start Date End Date Check Date
EMPLOYEE NAME
Employee Telephone
Employee Street Address 1
Employee Street Address 2
City, State Zip
 09/20/2022 10/19/2022 10/20/2022
Earnings Rate Hours Current Year to Date
Regular 10.00 40.00 400.00 4,000.00
Salary 10.00 40.00 400.00 4,000.00
Contract 10.00 40.00 400.00 4,000.00
Overtime 0.00 0.00 0.00 0.00
Holiday 0.00 0.00 0.00 0.00
Vacation 0.00 0.00 0.00 0.00
Bonus 0.00 0.00 0.00 0.00
Tips 0.00 0.00 0.00 0.00
Deductions Current Year to Date
FICA - Medicare 400.00 4,000.00
FICA - Social Security 400.00 4,000.00
Federal Tax 400.00 4,000.00
State Tax 400.00 4,000.00
SDI 400.00 4,000.00
SUI 400.00 4,000.00
WC 400.00 4,000.00
FLI 400.00 4,000.00
Workforce Development 400.00 4,000.00
Gross Earnings $27,220.00 $272,200.00
Gross Deductions $8,818.96 $97,303.60
  Check No. #1234
  Net Pay $600.00
  YTD Net Pay $600.00
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Company Name
4654445544
Company Street Address 1
Company Street Address 2
City, State Zip

Earnings Statement

Period Ending: 10/20/2022
Pay Date: 10/21/2022
EMPLOYEE NAME
Employee Telephone
Employee Street Address 1
Employee Street Address 2
City, State Zip
Earnings Rate Hours This Period Year to Date
Regular 10.00 40.00 400.00 4000.00
Salary 10.00 40.00 400.00 4000.00
Contract 10.00 40.00 400.00 4000.00
Overtime 10.00 40.00 400.00 4000.00
Holiday 10.00 40.00 400.00 4000.00
Vacation 10.00 40.00 400.00 4000.00
Bonus 10.00 40.00 400.00 4000.00
Tips 10.00 40.00 400.00 4000.00
Gross Pay $400.00 $4000.00
Deductions Type This Period Year to Date
FICA - Medicare 400.00 4000.00
FICA - Social Security 400.00 4000.00
Federal Tax 400.00 4000.00
State Tax 400.00 4000.00
SDI 400.00 4000.00
SUI 400.00 4000.00
WC 400.00 4000.00
FLI 400.00 4000.00
Workforce Development 400.00 4000.00
 
Net Pay $400.00 $4000.00
Your deductions for this period are $37.43
Cut Maker
Company Name
4654445544
Company Street Address 1
Company Street Address 2
City, State Zip
 Payroll Check Number: 8963
Pay Date: 10/21/2022
Employee Name
Three Hundred Sixty Two And 57/100 Dollars 362.57
Authorized Signature

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