U.S. Department of Labor PAYROLL - Forms in Word

U.S. Department of Labor

Wage and Hour Division

NAME OF CONTRACTOR

NAME OF COMPANY HERE

PAYROLL NO.

PAYROLL

(For Contractor's Optional Use; See Instructions at esa/whd/forms/wh347instr.htm)

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.

OR SUBCONTRACTOR

ADDRESS

Rev. Dec. 2008 OMB No.: 1235-0008

Expires: 01/31/2015

COMPLETE ADDRESS HERE

FOR WEEK ENDING

PROJECT AND LOCATION

PROJECT OR CONTRACT NO.

PAYROLL NO. HERE

Thursday, February 07, 2008

PROJECT LOCATION HERE

PROJECT NUMBER HERE

(1)

(2)

NAME AND INDIVIDUAL IDENTIFYING NUMBER (e.g., LAST FOUR DIGITS OF SOCIAL SECURITY

NUMBER) OF WORKER Name Here

4 Last 4 Social Security No. Here

NO. OF WITHHOLDING EXEMPTIONS

OT OR ST

(3)

WORK CLASSIFICATION

(4) DAY AND DATE

(5)

F S S M TWU

1/1 1/2 1/3 1/4 1/5 1/6 1/7 HOURS WORKED EACH DAY

TOTAL HOURS

(6)

RATE OF PAY

(7)

GROSS AMOUNT EARNED

FICA

WITHHOLDING

TAX

(8) DEDUCTIONS

O

0

SUPERVISOR

S8 0

8

0

$ -$

-

$ 22.60 $ 5.00 $ - $ -

16

$ 25.00 $ 400.00

(9)

OTHER

TOTAL DEDUCTIONS

NET WAGES

PAID FOR WEEK

$ 5.00 $ 32.60 $ 367.40

Name Here Last 4 Social Security No. Here

O

0

0

$

-$

-

2

LABORER

$ 6.33 $ 5.00 $ - $ - $ 5.00 $

16.33 $ 95.67

S0 8 0 0 0 0 0

8

$ 14.00 $ 112.00

Name Here Last 4 Social Security No. Here

O

0

0

$

-$

-

1

LABORER

$ 10.85 $ 5.00 $ - $ - $ 5.00 $

20.85 $ 171.15

S0 8 8 0 0 0 0

16

$ 12.00 $ 192.00

Name Here Last 4 Social Security No. Here

O

0

0

$

-$

-

1

LABORER

$ 5.88 $ 5.00 $ - $ - $ 5.00 $

15.88 $ 88.12

S0 8 0 0 0 0 0

8

$ 13.00 $ 104.00

Name Here

3 Last 4 Social Security No. Here

O

0

S0 8 0 0 0

0

$

-$

-

$ 8.59 $ 5.00 $ - $ - $ 5.00 $

18.59 $ 133.41

8

$ 19.00 $ 152.00

Name Here

5 Last 4 Social Security No. Here

O

0

S0 8 0 0 0

0

$

-$

-

$ 4.52 $ 5.00 $ - $ - $ 5.00 $

14.52 $ 65.48

8

$ 10.00 $

80.00

Name Here

1 Last 4 Social Security No. Here

O

0

S8 0 0 0 0

0

$

-$

-

$ 4.52 $ 5.00 $ - $ - $ 5.00 $

14.52 $ 65.48

8

$ 10.00 $

80.00

Name Here

1 Last 4 Social Security No. Here

O

0

S8 0 0 0 0

0

$

-$

-

$ 4.52 $ 5.00 $ - $ - $ 5.00 $

14.52 $ 65.48

8

$ 10.00 $

80.00

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