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XXX-XX-
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SEQ:
38006
Earnings Statement
Employee name/address
ssn
reporting period
04/24/2026-04/30/2026
pay date
2026-05-02
EMPLOYEE No.
1
Income
Rate
HRS
Current Pay
Gross Earnings
458.80
Deductions
Total TAX
YTD Total
Statutory Deductions
Fica - Medicare
6.65
119.70
Fica - Social Security
28.45
512.10
Federal TAX
19.25
346.50
YTD Gross
8,258.40
YTD Deductions
978.30
YTD Net Pay
7,280.10
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
2026-05-02
38006
THIS IS NOT A CHECK
Non Negotiable
VOID
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