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CO. FILE DEPT. CLOCK VCHR. NO.

020
CHA 001061 000300 0000120005 1 Earnings Statement
TLE NY LLC Period Beginning: 11/01/2021
86 PURCHASE STREET Period Ending: 11/15/2021
RYE, NY 10580 Pay Date: 11/19/2021

Taxable Marital Status: Single JOHN RYAN ROSA


Exemptions/Allowances: 57 STILLWATER AVE
APT 311
Federal: 0
NY: 0
STAMFORD, CT 06902

rate hours this period year to date


Regular 15 0000 80 00 1 200 00 2 400 00 YOUR COMPANY PHONE NUMBER IS 203-521-6709
Overtime 22 5000 26 27 591 08 22 089 01
Gross Pay $1 791 08 63 409 09 BASIS OF PAY: HOURLY

Statutory
Federal Income Tax -199 97 379 44
Social Security Tax -111 05 216 32
Medicare Tax -25 97 50 59
NY State Income Tax -81 70 157 73
NY SUI/SDI Tax -1 20 2 40
NY Paid Family Leave Ins -4 84 9 42

Net Pay $1 366 35


Checking 1 -1 366 35

Net Check $0 00

Your federal taxable wages this period are


$1 791 08

2000 A DP, LLC

TLE NY LLC Advice number: 00000120005


86 PURCHASE STREET Pay date: 11/19/2021
RYE NY 10580

Deposited to the account of account number transit ABA amount


JOHN RYAN ROSA xxxxx9799 xxxx xxxx $1 366 35

NON-NEGOTIABLE

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