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XXX-XX-
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SEQ:
47129
Earnings Statement
Employee name/address
ssn
reporting period
04/12/2026-04/18/2026
pay date
2026-04-20
EMPLOYEE No.
1
Income
Rate
HRS
Current Pay
Gross Earnings
458.80
Deductions
Total TAX
YTD Total
Statutory Deductions
Fica - Medicare
6.65
113.05
Fica - Social Security
28.45
483.65
Federal TAX
19.25
327.25
YTD Gross
7,799.60
YTD Deductions
923.95
YTD Net Pay
6,875.65
Total
458.80
Deductions
54.35
Net Pay
404.45
STATEMENT OF EARNINGS AND DEDUCTIONS • DETACH AND KEEP FOR YOUR RECORDS
Pay
** 404 ** DOLLARS AND ** 45 ** CENTS
To the order of:
Check Date
Check Number
2026-04-20
47129
THIS IS NOT A CHECK
Non Negotiable
VOID
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