CO FILE DEPT CLOCK VCHH NO.

QX4 005702 000807 3563 0000490812 1 Earnings Statement

SEQ 014735 Period Befinning: 11/16/2023
FLAGSHIP FACILITY SERVICES, INC
405 S KIMBALL AVE Period Edning: 11/30/2023
SOUTHLAKE, TX 76092 Pay Date: 12/08/2023
PHONE # (972) 574-9702

MARTIN A ORTIZ LEON

Filing Status: Single, Married filing separately
Exemptiones/Allowances 779 EVERLYN
Federal: Standard Withholding Table APT 212
MOUNTAIN VIEW CA 94041

Earnings_____ _ rate hours this period year to day Other Benefitts and
Regular 25,9500 70.00 1,816.50 46,398.06 Informatión___________this period__ total to date
Sick 973,13 Sick Accrued 30.12
Vacation 1,855,43 Vacation Bal 92.66
Grosa Pay $2,281.01 51,720.68

Totl Hrs Worked 71.90

Deductions Statutory_______________________ Init Fee 876 106.40
Federal Income Tax -195.30 4,422.62
Social Security Tax -141.42 3,206.68 Employee ID 929503
Medicare Tax -33.07 749.95
CA State Income Tax -37.69 860.03
Important Notes______________________________________
CA SDI Tax -20.53 465.49
YOUR COMPANY’S ER PHONE NUMBER IS 408-977-0155
Other__________________________
Dues Local 19m -25.90 595.70 Additional Tax Withholding Information___________________
Cell Ph Stip - 97.06 Taxable Marital Status:
CA: Married
Adjustment_____________________ Exemptions/Allowances:
Cell Ph Stip +4.22
CA: 0
Net Pay $1,831.32
Checking -1,831.32

Net Check $0.00

Your Federal taxable wages this period are

$2,281.0