// total deduction this perio

C O . FILE DEPT. CLOCK NUMBER

SBINC 526543 103216 9234519129 0
Earnings Statement
Western Business Solutions Period ending:
08/13/2004
11808 Miracle Hills Dr. Pay date:
08/20/2004
Omaha NE 68154
Taxable Marital Status: 1
Exemptions/Allowances:
Reynaldo Ayala-Hernandez
Federal: 3, $25 Additional Tax 420 16th St. Apt 4
State: 2
Sparks, NV. 89431
Local: 1
xxx-xx-5303
Earnings rate hours this period year to date Important Notes
Regular 9.00 80.00 720.00 720.00
PAY PERIOD - REGULAR - NON-EXEMPT
Overtime 13.50 0.00 0.00 0.00
Bonus -- -- 0.00 0.00
CURRENT PAY RATE IS: $9.00 PER HOUR.
-- -- 0.00 0.00
-- 0.00 0.00
Commission -- -- 0.00 0.00
REMEMBER OUR UNITED WAY FUND DRIVE
720.00
Deductions Statutory
Federal Income Tax - 91.27 91.27
Social Security Tax - 44.64 44.64
Medicare Tax - 10.44 10.44
State Income Tax - 0.00 0.00
Local Tax / SDI - 0.00 0.00
Other
401(k) - 0.00 0.00
Medical - 0.00 0.00
Garnish -0.00 0.00
Total Deductions -146.35 -146.35
573.65
* Excluded from federal taxable wages
Western Business Solutions Payroll check number: 19129
3 2 7 2 8 3 1 0 E
11808 Miracle Hills Dr. Pay date: 08/20/2004
Omaha 68154
Pay to the
order of:
Ayala-Hernandez Reynaldo
This amount:
573.65
NATIONAL BANK
AUTHORIZED SIGNATURE
STREET ADDRESS
VOID VOID VOID
CITY STATE ZIP
VOID AFTER 90 DAYS
001379 1220004964040110157
DIRECT DEPOSIT - DO NOT CASH - THIS IS NOT A CHECK
HOLD AT AN ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENT.
Net Pay
Gross Pay