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XXX-XX-
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20090
Earnings Statement
Employee name / address
SSN
REPORTING PERIOD
04/12/2026-04/18/2026
PAY DATE
04/20/2026
EMPLOYEE No.
1
Income
Rate
HRS
Current Pay
Deductions
Total
YTD Total
Gross Earnings
458.80
Statutory Deductions
Fica - Medicare
6.65
113.05
FICA - SOCIAL SECURITY
28.45
483.65
FEDERAL TAX
19.25
327.25
YTD Gross
YTD Deductions
YTD NET PAY
TOTAL
DEDUCTIONS
NET PAY
7,799.60
923.95
6,875.65
458.80
54.35
404.45
Pay
** 404 ** ** DOLLARS AND ** 45 ** cents
To the order of:
Check Date
Check Number
2026-04-20
20090
THIS IS NOT A CHECK
Non-Negotiable
VOID
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