EMPLOYEE EARNINGS RECORD
Employee's Name: Address: City: Social Security Number:
Payroll Period Ending
Total Hours
J A N
Monthly Total
F E B
Monthly Total
M A R
Monthly Total Quarterly Total
A P R
Monthly Total
M A Y
Monthly Total
J U N
Monthly Total Quarter Total Year to Date Total
State:
Gross Wages
FICA
EMPLOYEE EARNINGS RECORD
Year _________
Zip:
Withholdings
Net
Federal
State
Other:
Pay
Tax
Tax
Payroll Period Ending
Total Hours
J U L
Monthly Total
A U G
Monthly Total
S E P
Monthly Total Quarterly Total
O C T
Monthly Total
N O V
Monthly Total
D E C
Monthly Total Quarter Total Year to Date Total
Gross Wages
Number of Exemptions: Additional Withholding:
(FED) (FED)
FICA
Withholdings
Federal
State
Tax
Tax
Page A-16
(STATE) (STATE)
Net
Other:
Pay
Employee's Name: Address: City: Social Security Number:
Payroll Period Ending
Total Hours
J A N
Monthly Total
F E B
Monthly Total
M A R
Monthly Total Quarterly Total
A P R
Monthly Total
M A Y
Monthly Total
J U N
Monthly Total Quarter Total Year to Date Total
State:
Gross Wages
FICA
EMPLOYEE EARNINGS RECORD
Year ________
Zip:
Withholdings
Net
Federal
State
Other:
Pay
Tax
Tax
Payroll Period Ending
Total Hours
J U L
Monthly Total
A U G
Monthly Total
S E P
Monthly Total Quarterly Total
O C T
Monthly Total
N O V
Monthly Total
D E C
Monthly Total Quarter Total Year to Date Total
Gross Wages
Number of Exemptions: Additional Withholding:
(FED) (FED)
FICA
Withholdings
Federal
State
Tax
Tax
Page A-16
(STATE) (STATE)
Net
Other:
Pay
................
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