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DATE

AMOUNT

PAY

PAY TO THE
ORDER OF

FILE RECORD
FILE RECORD
AUTHORIZED SIGNATURE

,
Employee Number:
Department Number:
Social Security Number:
Withholding Allowances:

M0

Earnings
Description

Hours

Total Earnings

05/11/2016

NET PAY:

***0.00

Taxes

This Period

SALARY
SALARYII

Pay Day:
Pay Period:
Pay Rate:

Year-To-Date

0.00

0.00

0.00

0.00

0.00

0.00

Description

Deductions / Miscellaneous Items

This Period

Year-To-Date

Description
HEALTH INSURANC

0.00

Total Taxes

0.00

This Period
0.00

Year-To-Date
0.00

0.00

0.00

Total Deductions

,
Employee Number:
Department Number:
Social Security Number:
Withholding Allowances:

,
Earnings
Description

Hours

M0

Pay Day:
Pay Period:
Pay Rate:

05/11/2016

NET PAY:

***0.00

Taxes

This Period

Year-To-Date

SALARY
SALARYII

0.00

0.00

0.00

0.00

Total Earnings

0.00

0.00

Description

Deductions / Miscellaneous Items

This Period

Year-To-Date

Description
HEALTH INSURANC

Total Taxes

0.00

0.00

Total Deductions

This Period
0.00

Year-To-Date

0.00

0.00

0.00

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