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CO. FILE DEPT. CLOCK VCHR. NO.

TQC 224873 3523 0000430285 1


Earnings Statement
MAPCO EXPRESS INC Period Beginning: 10/15/2022
801 CRESCENT CENTRE DR, STE 300 Period Ending: 10/21/2022
FRANKLIN, TN 37067 Pay Date: 10/28/2022
615-994-0600

RACHEL D BUMGARDNER
Filing Status: Single/Married filing separately 1647 AL HWY 75
Exemptions/Allowances:
Federal: Tax blocked
FLAT ROCK AL 35966

rate hours this period year to date


Cust Serv Ldr 12 2500 33 60 411 60 9 960 13 Taxable Marital Status:
GA: Single
Third Shift Dif 13 2500 6 00 79 50 972 58
Exemptions/Allowances:
Cust Ldr Ot 2 280 75 AL: 0
Hol Wk 1 5 318 26 GA: 0
Third Shift Ot 372 97
Gross Pay $491 10 13 904 69

Statutory
Social Security Tax -30 45 862 09
Medicare Tax -7 12 201 62
GA State Income Tax -18 95 585 82

Acc Base Cov -2 08 35 36


Critical Ill Ee -0 48 8 16
Indemnity -9 44
Vol Life Ee -0 16 2 72

Net Pay $422 42


Checking -422 42

Net Check $0 00

Your federal taxable wages this period are $491 10

Taxable Marital Status:


AL: Single

2000 ADP, Inc.

MAPCO EXPRESS INC Advice number: 00000430285


801 CRESCENT CENTRE DR STE 300 Pay date: 10/28/2022
FRANKLIN TN 37067
615-994-0600

Deposited to the account of account number transit ABA amount


RACHEL D BUMGARDNER xxxxxxxxx3561 xxxx xxxx $422 42

NON-NEGOTIABLE

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