GOODWILL INDUSTRIES OF HOUSTON AQUAMAINE THOMAS

1140 WEST LOOP N EMPLOYEE ID: 81541

HOUSTON TX 77055 DEPARTMENT: 1165274
DD RECEIPT: 1022941104

FEIN: 74-1285095
Pay Period 12/25/2022 - 01/07/2023 FITWH Filing Status: S
Pay Date 01/13/2023 TX

Earnings RATE HOUR/UNIT CURRENT YTD HOUR/UNIT YTD

Hourly 12.00 67.5667 810.80 67.5667 810.80
Total 67.5667 $810.80 67.5667 $810.80
Total Hours Worked 67.5667 67.5667

Deductions CURRENT YTD Taxes CURRENT YTD

Dental 4.47 4.47 FITWH 20.97 20.97
Medical 61.58 61.58 MED 10.76 10.76
Vision 2.34 2.34 SOC 46.03 46.03
VLTD21 7.78 7.78 Total $77.76 $77.76
Vol EE 5.08 5.08
VSTD21 5.85 5.85 Net Pay XXXXXXXX974 $645.94
Total $87.10 $87.10

THIS IS NOT A CHECK. THIS DOCUMENT IS TO BE USED FOR INFORMATIONAL PURPOSES ONLY.

GOODWILL INDUSTRIES OF HOUSTON

1140 WEST LOOP N
HOUSTON TX 77055 Direct Deposit # 1022941104
Date 01/13/2023

Pay this Amount

** N O N - N E G O T I A B L E ** D I R E C T D E P O S I T R E C E I P T ** VOID ** VOID **

DIRECT DEPOSIT $645.94

1165274 DD TO ACCOUNT # XXXXXXXX9747
Pay to the BANK # XXXXX9019
Order of AQUAMAINE THOMAS
18502 SOLACE VISTA DR
NON-NEGOTIABLE
CYPRESS TX 77433