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Payroll and Earnings Statement
|Employer | |
|Employee Name | |Employee Number | |
|Salary For The Period: |
|Beginning | |Ending | |
|Earnings |
| |Sunday |Monda|
| | |y |
|Other Amounts Due – Commission, Special Allowances Etc. | | |
|Total Wages Or Salary | | |
|Gratuity / Tips Received directly By The Employee | | |
|Total Earnings | | |
|Tax Deductions |
|FICA | | |
|Federal Income Tax Withheld | | |
|State Income Tax Withheld | | |
| | | |
| | | |
|Less total Tax deductions | | |
|Net earnings after deductions | | |
|Other Deductions |
|Non Cash Compensation. | | |
|Gratuity / Tips Received directly By The Employee | | |
|Total of all other deductions | | |
|Paid in Cash □ or Check □ or Account Transfer □ or other □ – Specify ___________ Net Amount Due : | | |
I certify the correctness of the above calculations and acknowledge the receipt of the net amount due to me.
Employee’s Signature _____________________________________ Date _________________________
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