CO. FILE DEPT. CLOCK VCHR. NO.

036
HVA 002788 000201 0000440210 1 Earnings Statement
PAN PEPIN INC Period Beginning: 10/24/2021
PO BOX 100 Period Ending: 10/30/2021
BAYAMON, PR 00960-0100 Pay Date: 11/04/2021

ERIC B LOPEZ PEREZ

Filing Status: Single/Married
Exemptions/Allowances:
Federal: Tax Exempt
filing separately URB. SANTA JUANITA
CALLE CIPRES #EJ-19
BAYAMON PR 00956

rate hours this period year to date Other Benefits and

Regular 9 0000 47 25 425 25 891 00 this period total to date
Overtime 13 5000 25 3 38 3 38 Totl Hrs Worked 47 50
Gross Pay $428 63 894 38
Title ASH

Statutory
COMPANY PH#:(787) 787-1717
Social Security Tax -26 57 55 45
Medicare Tax -6 22 12 97
BASIS OF PAY: HOURLY
PR State Income Tax -6 45 6 45

Incap Privado -0 49 1 03
Taxable Marital Status:
Net Pay $388 90 PR: Single
Exemptions/Allowances:
Chequera -388 90 PR: $3500 Annual Exemption
Net Check $0 00

2000 A DP, LLC

PAN PEPIN INC Advice number: 00000440210

PO BOX 100 Pay date: 11/04/2021
BAYAMON PR 00960-0100

Deposited to the account of account number transit ABA amount

ERIC B LOPEZ PEREZ xxxxx5043 xxxx xxxx $388 90

NON-NEGOTIABLE