CO. FILE DEPT.

CLOCK NUMBER
ABC 126543 123456 12345 00000000
1 Earnings Statement
ACME SUPPLIES CORP. Period ending: 7/18/2008
475 KNAPP AVENUE Pay date: 7/25/2008
ANYTOWN, USA 10101

Social Security Number: 999-99-9999 JANE HARPER

Taxable Marital Status: Married
Exemptions/Allowances: 101 MAIN STREET
Federal: 3, $25 Additional ANYTOWN, USA 12345
Tax State: 2
Local: 2

Earnings rate hours this periodyear to date Other Benefits and

10.00
Regular Overtime 32.00
Holiday Tuition 320.0016,640.00 Information this periodtotal to date
15.00 1.00 15.00780.00 Group Term Life Loan Amt Paid 0.5127.00
10.00 8.00 80.004,160.00 840.00
37.43*1,946.80

Gross Pay $ 452.43 Vac Hrs 40.00

23,526.80
Sick Hrs Title 16.00
Deductions Statutory Operator
Federal Income Tax - 40.60 2,111.20
Social Security Tax Medicare- 28.05
Tax 1,458.60
NY State Income Tax NYC Income- 6.56Tax 341.12 Important Notes
NY SUI/SDI Tax - 8.43 438.36 EFFECTIVE THIS PAY PERIOD YOUR REGULAR
- 5.94 308.88
- 0.60 31.20 HOURLY RATE HAS BEEN CHANGED FROM $8.00
TO $10.00 PER HOUR.

©2008, 2001, 2000, 1999 ADP, Inc.

Other
Bond - 5.00 100.00 WE WILL BE STARTING OUR UNITED WAY FUND
401(k) - 28.85* 1,500.20 DRIVE SOON AND LOOK FORWARD TO YOUR
Stock Plan Life Insurance Loan
-15.00 150.00 PARTICIPATION.
- 5.00 50.00
- 30.00 150.00

Adjustment
Life Insurance+ 13.50

Net Pay $ 291.90

* Excluded from federal taxable wages

TEAR
Your federal wages this period are $386.15

ACME SUPPLIES CORP. Payroll check number:0000000000

475 KNAPP AVENUE ANYTOWN, USA 10101 Pay date:7/25/2008
Social Security No.999-99-9999

Pay to the order of:

This amount: JANE HARPER
TWO HUNDRED NINETY-ONE AND 90/100 DOLLARS
$291.90

SAMPLE

BANK NAME STREET ADDRESS CITY STATE ZIP SAMPLE

NON-NEGOTIABLE VOID VOID VOID
AUTHORIZED SIGNATURE
VOID AFTER 90 DAYS

½001379½ 122000496 4040110157½

THE ORIGINAL DOCUMENT HAS A REFLECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENT.