 |
| Statement of Earnings and Deductions | |
Name
|
SSN
|
Pay Date
|
Net Pay
|
| FIRST LAST |
XXX-XX-XXXX | 09/21/2009 | 3,059.78 | |
Location
|
Marital Status
|
Exemptions
|
Number
|
| XXX | M | 1.00 |
XXXXXX |
|
| Paid Time Off | |
Description
|
Earned
|
Used
|
Balance
| | Vacation | 145.00 | 46.00 | 99.00 | | Sick | 0.00 | 0.00 | 0.00 | | Comp Time | 0.00 | 0.00 | 0.00 | | Emergency | 0.00 | 0.00 | 0.00 |
| |
| Earnings Summary | |
Description
|
Current
|
YTD
| |
Hrs/Days
| 0.00 | |
|
Regular
| 4,643.79 | |
|
Other
| 0.00 | |
|
Ded Abs
| 0.00 | |
|
Gross Pay
| 4,643.79 | 84,968.95 | | Withholdings | |
FICA
| 344.95 | 6,400.29 | |
Federal Tax
| 707.49 | 13,263.53 | |
State Tax
| 255.46 | 4,563.15 | |
Retire
| 0.00 | 0.00 | | Voluntary Deductions | |
Tax Shelter
| 134.66 | 1,305.00 | |
Other
| 141.45 | 2,546.86 |
|
| Earnings Detail | |
Earn Code
|
Hrs/Days
|
Rate
|
Prog #
|
Description
|
Amount
| | 013 | | | 0990 | DISTRICT OFFICE | 1,393.14 | | 013 | | | 0990 | DISTRICT OFFICE | 3,250.65 |
|
| Voluntary Deductions | |
Description
|
Current
|
YTD
| | EMIA FLEXIBLE SPENDING | 86.00 | 668.00 | | FLEX SPEND LIFE INSURA | 4.40 | 68.00 | | IRON COUNTY SCHOOL ADM | 3.00 | 54.00 | | HORACE MANN INSURANCE | 1.90 | 34.20 | | IRON DISTRICT FOUNDATI | 10.00 | 180.00 | | CENTRAL OFFICE ACCOUNT | 3.00 | 70.00 | | HARTFORD (LIFE INSURAN | 15.85 | 270.06 | | CAPITAL AMERICAN CANCE | 14.75 | 265.50 | | PRE PAID LEGAL SERVICE | 12.95 | 233.10 | | FLEX EMIA TWO-PARTY PR | 39.56 | 484.40 | | FLEX DENTAL - COUPLE | 4.70 | 84.60 | | BENEFICIAL LIFE | 80.00 | 1,440.00 | | EXTRA STATE TAX DEDUCT | 30.00 | 380.00 |
| |
| Direct Deposit | |
Bank Name
|
Account #
|
Type
|
Amount
| | STATE BANK OF SOUTHERN UTAH |
*
*
*
*
*
*
*
*1171 | Checking | 1,559.78 | | ALLEGIANCE DIRECT BANK |
*
*
*
*
*
*1877 | Checking | 1,500.00 |
|
|