CO. FILE DEPT. CLOCK VCHR. NO.

BK5 335309 008001 0000521996 1

Earnings Statement
049-0045
PACKERS SANITATION SERVICES, LTD., LLC Period Beginning: 12/17/2018
3681 PRISM LANE Period Ending: 12/23/2018
KIELER, WI 53812 Pay Date: 12/28/2018
888-871-6335

Taxable Marital Status: Single ELIZABETH M HERNANDEZ

Exemptions/Allowances: 503 W 8TH ST TRLR D
Federal: 3
IA: 3
STORM LAKE IA 50588

rate hours this period year to date Other Benefits and

Regular 895 20 40 00 895 20 43 864 80 this period total to date
Special 179 04 6 087 36 Hours Worked 40 00
Vacation 2 685 60
Vacation Bal 80 00
Gross Pay $1 074 24 52 637 76

YOUR COMPANY PHONE NUMBER IS 888-871-6335

Statutory
Federal Income Tax -84 78 4 089 63
CONFIRM YOUR NAME/ADDRESS FOR 2018 W2S. LOG ONTO
Social Security Tax -64 95 3 177 56
SELF-SERVICE OR CALL PSSI AT 608-568-3413 TO UPDATE
Medicare Tax -15 19 743 14
IA State Income Tax -49 75 2 361 85

Dental Pre Tax -5 00* 260 00

Medical Pre Tax -20 00* 1 040 00
Vision -1 67* 86 84
Expense Reimb -296 11
Expense Reimb 2 -1 60

Net Pay $832 90

Checking -832 90

Net Check $0 00

Excluded from federal taxable wages

Your federal taxable wages this period are

$1 047 57

2000 A DP, LLC

PACKERS SANITATION SERVICES LTD LLC Advice number: 00000521996

3681 PRISM LANE Pay date: 12/28/2018
KIELER WI 53812
888-871-6335

Deposited to the account of account number transit ABA amount

ELIZABETH M HERNANDEZ xxxxxx5785 xxxx xxxx $832 90

NON-NEGOTIABLE