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ABC Corp. Employee Name: Mary Smith
450 Chamber Street Social Security #: 999-99-9999
Somewhere, USA 01010 Period End Date: 01/07/05
Wages Deductions
Current Y-T-D Current Y-T-D
Description Hours Rate Amount Amount Description Amount Amount
1
2
3
Regular
Overtime
Holiday
Tuition
40.00
1.00
10.00
15.00
400.00
15.00
37.43*
400.00
15.00
0.00
37.43
Federal Withholdings
Social Security Tax
Medicare
Tax
NY State
Income Tax
NYC Income Tax
NY SUI/SDI Tax
Other
401(k)
Life Insurance
Loan
Dental
HMO
Dep Care FSA
37.29
24.83
5.81
8.26
5.11
0.61
27.15*
2.00
30.00
2.00*
20.00*
30.00*
37.29
24.83
5.81
8.26
5.11
0.61
27.15
2.00
30.00
2.00
20.00
30.00
Totals
452.43 452.43
Deduction Totals
193.06 193.06
Taxable Gross
335.85 335.85
NET PAY
259.38 259.38
1
Details of
applicable
federal,
state, and
local taxes
paid.
3
Flexible
Spending
Accounts
(for health
care, child
or
dependant
care,
parking
expenses)
are pre-tax
deductions.
2
401(k)
savings is a
pre-tax
deduction.
• Excluded from federal taxable wages
ABC Corp. Payroll Advice # 00000000
450 Chamber Street Advice of Credit Date 1/07/2005
Somewhere, USA 01010
Pay TWO HUNDRED FIFTY NINE AND 38/100 DOLLARS
To the MARY SMITH
Order of 215 MAIN STREET
ANYTOWN, USA 98765
NON-NEGOTIABLE