CO. FILE DEPT. CLOCK VCHR. NO.

0KR 223285 591600 X4505 0000481737 1

Earnings Statement
Page 1 (Con’t Next Page)
BLACK HORSE CARRIERS LLC Period Beginning: 11/20/2022
2675 MORGANTOWN ROAD Period Ending: 11/26/2022
READING, PA 19607 Pay Date: 12/02/2022

LAZARO ALBERTO HERNANDEZ ROQUE

Filing Status: Single/Married filing separately 2670 WILKENS AVE
Exemptions/Allowances:
BALTIMORE MD 21223
Federal: Standard Withholding Table

rate hours this period year to date

Dl Stop 180 00 8 062 00
Your federal taxable wages this period are
Holiday 260 00 1 040 00
$1 247 00
Meeting 25 00 25 00
Tier Band Mls 486 62 19 883 04 Other Benefits and
Weekly Guard 295 38 12 835 38 this period total to date
Dot Physical 75 00 Tier Band Mils 486 62
Drive Detention 25 50
Incentive 200 00
Route Premium 21 500 00
Single Mileage 7 553 08
PLEASE REVIEW THAT YOUR ADDRESS IS CORRECT FOR
Gross Pay $1 247 00 71 199 00
W-2 PURPOSES.IF INCORRECT, VISIT HR SELF SERVICE
Your SSOID is 600223285
Statutory
Federal Income Tax -135 26 9 127 79
Taxable Marital Status:
Social Security Tax -77 32 4 414 34 MD: Single
Medicare Tax -18 09 1 032 39 NJ: Single
NJ State Income Tax -44 43 1 828 25 Exemptions/Allowances:
MD: 0
NJ SDI Tax -1 74 63 24
NJ: 0,Table A
NJ Paid Family Leave Ins -1 74 63 24
MD State Income Tax 1 924 35
Tr.Sheet/Date
____________ Desc
____ Hrs/Mls
_______ Earnings
________
NJ SUI Tax 133 03
1121 Tier Band Mls 222.87
1121 Meeting 25.00
Net Pay $968 42 Tr.Sheet/Date Total: 247.87
Checking -968 42 51 528 80 1122 Dl Stop 60.00
1122 Tier Band Mls 218.31
Net Check $0 00 Tr.Sheet/Date Total: 278.31
1123 Dl Stop 60.00
Tr.Sheet/Date Total: 60.00
1124 Dl Stop 60.00
1124 Tier Band Mls 45.44

2000 ADP, Inc.

BLACK HORSE CARRIERS LLC Advice number: 00000481737

2675 MORGANTOWN ROAD Pay date: 12/02/2022
READING PA 19607

Deposited to the account of account number transit ABA amount

LAZARO ALBERTO HERNANDEZ ROQUE xxxxxxxx5030 xxxx xxxx $968 42

NON-NEGOTIABLE
 CO. FILE DEPT. CLOCK VCHR. NO.
0KR 223285 591600 X4505 0000481737 1
Earnings Statement
Page 2
BLACK HORSE CARRIERS LLC Period Beginning: 11/20/2022
2675 MORGANTOWN ROAD Period Ending: 11/26/2022
READING, PA 19607 Pay Date: 12/02/2022

LAZARO ALBERTO HERNANDEZ ROQUE

Filing Status: Single/Married filing separately 2670 WILKENS AVE
Exemptions/Allowances:
BALTIMORE MD 21223
Federal: Standard Withholding Table

Tr.Sheet/Date
____________ Desc
____ Hrs/Mls
_______ Earnings
________
1124 Holiday 260.00
Tr.Sheet/Date Total: 365.44
1126 Weekly Guard 295.38
Tr.Sheet/Date Total: 295.38

Tr.Sheet/Date Total Earnings: 1,247.00

Special Services
________________ Quantity
______ Rate
____ Amount
______
DL STOP 15 00 12 00 180 00
HOLIDAY 8 00 32 50 260 00
MEETING 1 00 25 00 25 00
TIERED BANDED M 845 00 0 58 486 62
WEEKLY GUAR $ 1 00 295 38 295 38
Total: 1247 00

2000 ADP, Inc.

CONTINUED FROM PRIOR PAGE

YOUR VOUCHER IS PROVIDED ON PAGE 1

NON-NEGOTIABLE