Employee's Earnings Statement Name Document ID DOE, JANE ...

Employee's Earnings Statement

STATE OF MARYLAND COMPTROLLER OF MARYLAND 240109 CENTRAL PAYROLL BUREAU

EARNINGS REGULAR IMP INC HEALTH IMP INC DENTAL IMP INC PHARM

HOURS 80 0

CURRENT YEAR TO DATE

1709 18

1709 18

301 17

301 17

3 48

3 48

158 06

158 06

*STATE PAID BENEFITS* FICA SUBSIDY PHARMACY SUBSIDY DENTAL SUBSIDY RET/PEN SUB UNEMPL INS SUB HEALTH INS SUB

160 01 262 33

6 97 147 02

2 09 542 08

160 01 262 33

6 97 147 02

2 09 542 08

Name DOE, JANE

Regular Pay Rate 1709.18

Pay Period Ending Date 07-14-2009

Mar. Stat S

Fed Ex Additonal fed tax

00

1

MD FILING STATUS: SINGLE

St. Ex 00

Additional st. tax 0

Document ID RG9999

Check/Advice Number 99999999

County Code AA

TAXES/DEDUCTIONS

FEDERAL TAX FICA/MED STATE TAXES PHARMACY PLAN UCC DENTAL AD & D PLAN TX PHARMACY TX AETNA POS TX UCC DTL PPO IMP INC HEALTH IMP INC DENTAL IMP INC PHARM ST EMP ALT PEN DIRECT DEPOSIT AETNA POS

CURRENT

314 99 160 01 147 27

26 07 3 49 1 40

39 51 61 68

3 48 301 17

3 48 158 06

84 20 817 73

49 35

YEAR TO DATE

314 99 160 01 147 27

26 07 3 49 1 40

39 51 61 68

3 48 301 17

3 48 158 06

84 20 817 73

49 35

Current Year to Date

Earnings 2171 89 _ 2171 89

Taxes 622 27 _ 622 27

Deductions 731 89 731 89

J. DOE 1512 MAPLE LANE ANNAPOLIS, MD 21401

Example of Domestic Partner Deductions

Net Pay 817 73 817 73

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