0000*SAMPLE Sample Company, Inc. Page: 1
Earnings Record
December 1, 2000 to December 31, 2000
Gross Overtime Other 1099 FICA Medicare FWT 401k Misc Ded Net
Employee # 2 541-32-8861 Adler, Jimmy A. 321 Someother Street Garland, TX 75040
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10209 12/15/00 Adler, Jimmy A.
1,332.00 0.00 0.00 0.00 -82.58 -19.31 -141.99 0.00 -115.00 973.12
12015 12/31/00 Adler, Jimmy A.
1,480.00 0.00 0.00 0.00 -91.76 -21.46 -164.19 0.00 -115.00 1,087.59
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Current Totals
2,812.00 0.00 0.00 0.00 -174.34 -40.77 -306.18 0.00 -230.00 2,060.71
Quarterly Totals
11,520.50 0.00 0.00 0.00 -714.27 -167.05 -1,265.55 0.00 0.00 9,373.63
9,606.13 0.00 0.00 0.00 -595.58 -139.29 -1,094.05 0.00 -230.00 7,547.21
7,964.25 0.00 0.00 0.00 -493.78 -115.48 -905.57 0.00 -575.00 5,874.42
8,843.00 0.00 0.00 0.00 -548.27 -128.22 -979.59 0.00 -690.00 6,496.92
Year to Date Totals
37,933.88 0.00 0.00 0.00 -2,351.90 -550.04 -4,244.76 0.00 -1,495.00 29,292.18
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Employee # 4 745-25-9565 Bell, Mary Elizabeth 5965 Smart Court, #B-45 Dallas, TX 75228
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10210 12/15/00 Bell, Mary Elizabeth
650.00 0.00 0.00 0.00 -40.30 -9.43 -63.44 0.00 0.00 536.83
12016 12/31/00 Bell, Mary Elizabeth
650.00 0.00 0.00 0.00 -40.30 -9.42 -63.44 0.00 0.00 536.84
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Current Totals
1,300.00 0.00 0.00 0.00 -80.60 -18.85 -126.88 0.00 0.00 1,073.67
Quarterly Totals
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3,900.00 0.00 0.00 0.00 -241.80 -56.55 -380.64 0.00 0.00 3,221.01
Year to Date Totals
3,900.00 0.00 0.00 0.00 -241.80 -56.55 -380.64 0.00 0.00 3,221.01
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Employee # 3 000-00-0000 Campbell, Johnnie Sue 129 South Jones Dallas, TX 75228
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10211 12/15/00 Campbell, Johnnie Sue
1,000.00 0.00 0.00 0.00 -62.00 -14.50 -57.19 0.00 -95.00 771.31
12017 12/31/00 Campbell, Johnnie Sue
1,000.00 0.00 0.00 0.00 -62.00 -14.50 -57.19 0.00 -95.00 771.31
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Current Totals
2,000.00 0.00 0.00 0.00 -124.00 -29.00 -114.38 0.00 -190.00 1,542.62
Quarterly Totals
7,400.00 0.00 0.00 0.00 -458.80 -107.30 -367.48 0.00 0.00 6,466.42
5,800.00 0.00 0.00 0.00 -359.60 -84.10 -313.14 0.00 -190.00 4,853.16
4,985.00 0.00 0.00 0.00 -309.07 -72.28 -283.70 0.00 -475.00 3,844.95
6,000.00 0.00 0.00 0.00 -372.00 -87.00 -343.14 0.00 -570.00 4,627.86
Year to Date Totals
24,185.00 0.00 0.00 0.00 -1,499.47 -350.68 -1,307.46 0.00 -1,235.00 19,792.39
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