Work Sheet

COMPANY NAME EARNINGS STATEMENT Sample Company Name, Sample Address, 95220

EMPLOYEE NAME SOCIAL SEC. ID EMPLOYEE ID CHECK NO. PAY PERIOD PAY DATE

Sample Name XXX-XX-3432 44234 48869 1/29/16-2/11/16 2/12/16

INCOME RATE HOURS CURRENT TOTAL DEDUCTIONS CURRENT TOTAL YEAR-TO-DATE

REGULAR 15.00 80 1200.00 FICA MED TAX 17.40 52.20

FICA SS TAX 74.40 223.20

FED TAX 150.10 450.30

STATE TAX 0.00 0.00

YTD GROSS 3,600.00

YTD DEDUCTIONS 725.70

YTD NET PAY 2,874.30

CURRENT TOTAL 1,200.00

CURRENT DEDUCTIONS 241.90

NET PAY 958.10

COMPANY NAME EARNINGS STATEMENT Sample Company Name, Sample Address, 95220

EMPLOYEE NAME SOCIAL SEC. ID EMPLOYEE ID CHECK NO. PAY PERIOD PAY DATE

Sample Name XXX-XX-3432 44234 48869 1/29/16-2/11/16 2/12/16

INCOME RATE HOURS CURRENT TOTAL DEDUCTIONS CURRENT TOTAL YEAR-TO-DATE

REGULAR 15.00 80 1200.00 FICA MED TAX 17.40 52.20

FICA SS TAX 74.40 223.20

FED TAX 150.10 450.30

STATE TAX 0.00 0.00

YTD GROSS 3,600.00

YTD DEDUCTIONS 725.70

YTD NET PAY 2,874.30

CURRENT TOTAL 1,200.00

CURRENT DEDUCTIONS 241.90

NET PAY 958.10

COMPANY NAME EARNINGS STATEMENT Sample Company Name, Sample Address, 95220

EMPLOYEE NAME SOCIAL SEC. ID EMPLOYEE ID CHECK NO. PAY PERIOD PAY DATE

Sample Name XXX-XX-3432 44234 48869 1/29/16-2/11/16 2/12/16

INCOME RATE HOURS CURRENT TOTAL DEDUCTIONS CURRENT TOTAL YEAR-TO-DATE

REGULAR 15.00 80 1200.00 FICA MED TAX 17.40 52.20

FICA SS TAX 74.40 223.20

FED TAX 150.10 450.30

STATE TAX 0.00 0.00

YTD GROSS 3,600.00

YTD DEDUCTIONS 725.70

YTD NET PAY 2,874.30

CURRENT TOTAL 1,200.00

CURRENT DEDUCTIONS 241.90

NET PAY 958.10