CO. FILE DEPT. CLOCK VCHR. NO.

A02 243499 ORD000 0302 0000472629 1

Earnings Statement
COLOMBIA LLC Period Beginning: 12/27/2023
6030 W HAROLD GATTY DR. Period Ending: 01/09/2024
SALT LAKE CITY, UT 84102 Pay Date: 01/12/2024
COLOMBIA PAYROLL SERVICE CENTER: 888-874-7787

ADRIEL DELSON
Filing Status: Single/Married filing separately Exemptions/
Allowances:
738 S 1300 E.
Federal: Standard Withholding Table SALT LAKE CITY, UT 84102

rate hours this period year to date

Regular 18 2100 110 00 2 003 10 2 003 10
Your federal taxable wages this period
Shft2 Twu 0 2500 30 00 819 45 819 45
Addtl Hours 10 00 are $2 100 .32
Double Time 4 50 Other Benefits and
Floating Hol 0 00 this period total to date
Holiday Wrk Dt 0 00 Sick Balance 0 00
Overtime 30 00
Totl Hrs Worked 110 00
Sick Pay 0 00
Training Pay 0 00 Basis of Pay Hourly
Gross Pay $2 822 55 2 867 05 EMPLOYEE ID 00860898

Statutory BASIS OF PAY: HOURLY

Federal Income Tax -389 51 389 51
Social Security Tax -163 72 163 72 PLEASE VERIFY YOUR ADDRESS IS CORRECT FOR FORM
Medicare Tax -38 29 38 29 W-2YOU CAN UPDATE IT @ MYCOLOMBIA.COM BY 12/31/23
UT State Income Tax -130 71 130 71
Taxable Marital Status:
Un Dues Ea Twu 0 00 UT: Single
Exemptions/Allowances:
Init Fees Twu 0 00 UT: 0
Net Pay $2 100 32
Checking Dep 1 -1 859 03
Checking Dep 2 -200 00
Checking Dep 3 -41 29
Net Check $0 00

2000 ADP, Inc.

COLOMBIA LLC Advice number: 00000472629

6030 W HAROLD GATTY DR. Pay date: 01/12/2024
SALT LAKE CITY, UT 84102
COLOMBIA PAYROLL SERVICE CENTER: 888-874-7787

Deposited to the account of account number transit ABA amount

ADRIEL DELSON xxxxxxxx0951 xxxx xxxx $1 859 03
xxx8013 xxxx xxxx $200 00
xxxxx1655 xxxx xxxx $41 29

NON-NEGOTIABLE