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Advanced Employee Details (ID, Filing Status)
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Taxable Marital Status:
Exemptions:
Control #:
Correct value
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Employee Earning Statement
Period Ending:
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Pay Date:
Employee ID:
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Social Security Number:
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Earnings
Rate
Hours
This Period
Year To Date
Deductions
Statutory
This Period
Year To Date
Regular
Federal Income Tax
Social Security Tax
Medicare Tax
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Gross Pay
Net Pay
Pay
** 404 ** DOLLARS AND ** 45 ** cents
To the order of:
Check Date
Check number
2026-07-03
94238
This is not a check
Direct Deposit
Non-Negotiable
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Taxable Marital Status:
Single
Exemptions:
0
Control #:
94238
Employee Earning Statement
Period Ending:
06/25/2026-07/01/2026
Pay Date:
07/03/2026
Employee ID:
1
Social Security Number:
Earnings
Rate
Hours
This Period
Year To Date
Deductions
Statutory
This Period
Year To Date
Regular
458.80
12,387.60
Federal Income Tax
19.25
519.75
Social Security Tax
28.45
768.15
Medicare Tax
6.65
179.55
Gross Pay
458.80
12,387.60
Net Pay
404.45
10,920.15
Pay
** 404 ** DOLLARS AND ** 45 ** cents
To the order of:
Check Date
Check number
2026-07-03
94238
This is not a check
Direct Deposit
Non-Negotiable
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