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COMPANY NAME
COMPANY NAME
COMPANY ADDRESS, CITY, STATE ZIP
Employee ID
Employee Name
EMPLOYEE NAME
Employee Address
EMPLOYEE ADDRESS
CITY, STATE ZIP
CITY, STATE ZIP
Social Security No
XXX-XX-
Payment Period
03/22/2026 to 04/04/2026
Marital Status
Single
Distribution Type
Check
| Year to Date | |
|---|---|
| YTD Gross: | $600.00 |
| YTD Deduction: | $2,545.38 |
| YTD Net: | $-1,945.38 |
| Current | |
|---|---|
| Gross: | $1,600.00 |
| Deduction: | $242.02 |
| Net: | $1,357.98 |
| Payment Date | |
|---|---|
| Date: | 04/09/2026 |
| Earnings |
| Rate | Hours | Current Earnings | YTD | |
| Regular | $20.00 | 80.00 | $1,600.00 | $600.00 |
| Gross Earnings | $1,600.00 | $600.00 |
| Deductions |
| Current | YTD | |
| FICA - Medicare | $23.20 | $278.40 |
| FICA - Social Security | $99.20 | $1,190.40 |
| Federal Tax | $119.62 | $1,076.58 |
| State Tax | $0.00 | $0.00 |
| Total Deduction | $242.02 | $2,545.38 |
Remarks
PREVIEW ONLY
CO.
2rv
FILE
811139
DEPT
583670
CLOCK
17116
VCHR. NO
85576
062
COMPANY NAME
COMPANY ADDRESS
CITY, STATE ZIP
Social Security Number:
Taxable Marital Status:
Exemptions/Allowances:
Employee ID:
XXX-XX-
Single
1
Earnings
Rate
Hours
Amount
Year to Date
Regular
$20.00
80.00
$1,600.00
$600.00
Gross Pay
$1,600.00
Deduction
Statutory
FICA - Medicare
- $23.20
$278.40
FICA - Social Security
- $99.20
$1,190.40
Federal Tax
- $119.62
$1,076.58
State Tax
- $0.00
$0.00
Net Pay
$1,357.98
Check
-$1,357.98
Earnings Statement
Period Beginning:
Period Ending:
Pay Date:
03/22/2026
04/04/2026
04/09/2026
EMPLOYEE NAME
EMPLOYEE ADDRESS
CITY, STATE ZIP
Other benefits and
COMPANY NAME
COMPANY ADDRESS
CITY, STATE ZIP
Advice Number:
Pay date:
Social Security Number:
2037907
04/09/2026
XXX-XX-
Pay to the order of:
EMPLOYEE NAME
This amount:
one thousand three hundred fifty seven and 98/100 dollars
$1,357.98
NON-NEGOTIABLE
VOIDED CHECK
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