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XXX-XX-
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69787
Earnings Statement
Employee name / address
SSN
Reporting Period
Pay Date
Employee ID
06/01/2026-06/07/2026
06/09/2026
1
INCOME
RATE
HOURS
CURRENT PAY
DEDUCTIONS
TOTAL
YTD TOTAL
GROSS EARNINGS
458.80
STATUTORY DEDUCTIONS
FICA - Medicare
FICA - Social Security
Federal Tax W/H
6.65
28.45
19.25
159.60
682.80
462.00
YTD GROSS
YTD DEDUCTIONS
YTD NET PAY
TOTAL
DEDUCTIONS
NET PAY
11,011.20
1,304.40
9,706.80
458.80
54.35
404.45
Pay
** 404 ** DOLLARS AND ** 45 ** cents
To the order of:
Check Date
Check number
06/09/2026
69787
This is not a check
Direct Deposit
NON-NEGOTIABLE
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