Earnings Statement: Earnings Other Benefits and Information Deposits

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CO. FILE DEPT.

CLOCK NUMBER
AC5 8800xx 0785xx 007xxx 0215xxx 1 Earnings Statement
Company Name Period Beginning: 07/28/2019
Company Address Period Ending: 08/03/2019
Pay Date: 08/06/2019
Taxable Marital Status: SINGLE
Exemptions/Allowances:
Federal: 0
Full Name
MI: 0
Full Address

Earnings hours this period year to date Other Benefits and


Regular 40.00 0.00 0.00 Information this period total to date
Overtime Sick Hours 0.00 40.00
Holiday
Tuition Deposits
Gross Pay $0.00 0.00 Account No. XXXXXXXXXX1234
Transit/ABA
Deductions Statutory Pending
Fed Income Tax 0.00 0.00
Social Security 0.00 0.00
Medicare 0.00 0.00 Important Notes
MI Income Tax 0.00 0.00
Net Pay $0.00
* Excluded from federal taxable wages

©2008, 2001, 2000, 1999 ADP, Inc.


Your federal wages this period are $0.00

TEAR HERE

Company Name Payroll check number: 0215xxx


Company Address Pay date: 08/06/2021

Pay to the
order of: Full Name
This amount: NET PAY IN WORDS $0.00

VOID AFTER 180 DAYS

NON-NEGOTIABLE

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

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