CO. FILE DEPT. CLOCK VCHR. NO.

034
UVS 013134 104102 0000420051 1 Earnings Statement
AMANA SERVICES CORP Period Beginning: 10/04/2021
6700 SHROCK COURT Period Ending: 10/17/2021
COLUMBUS, OH 43229 Pay Date: 10/22/2021

JACOB METCALF
Filing Status: Single/Married filing separately 517 SPICER STREET
Exemptions/Allowances:
Federal: Standard Withholding Table
AKRON OH 44311

rate hours this period year to date Other Benefits and

Regular 9 2500 79 52 735 56 4 091 20 this period total to date
Overtime 160 54 Totl Hrs Worked 79 52
Commission 141 94
Gross Pay $735 56 4 393 68
BASIS OF PAY: HOURLY

Statutory
Taxable Marital Status:
Federal Income Tax -23 92 132 89 OH: Single
Social Security Tax -44 76 270 71 Exemptions/Allowances:
Medicare Tax -10 47 63 31 OH: 0
OH State Income Tax -10 37 61 44
Akron Income Tax -18 05 109 17

Child Support -28 25 113 00

Pretax Dental -10 24* 20 48
Pretax Vision -3 49* 6 98

Net Pay $586 01

Checking -586 01

Net Check $0 00

Excluded from federal taxable wages

Your federal taxable wages this period are $721 83

2000 A DP, LLC

AMANA SERVICES CORP Advice number: 00000420051

6700 SHROCK COURT Pay date: 10/22/2021
COLUMBUS OH 43229

Deposited to the account of account number transit ABA amount

JACOB METCALF xxxxx5713 xxxx xxxx $586 01

NON-NEGOTIABLE