DEPARTMENT OCCUPATION WORKS IN (STATE SEX E S. ACCOUNT NO. NAME . LAST FIRST MIDDLE F OTHER DEDUCTIONS INFORMATION SALARY WTH FILING GROUP INSURANCE UNION DUES OTHER WEEKLY RATE ALLOW. STATUS HOURLY RATE OVERTIME RATE 20 REGULAR EARNINGS OVERTIME EARNINGS CUMULATIVE DEDUCTIONS NET PAID PAYDAY EARNINGS FICA OTHER CK. HRS. RATE AMOUNT HRS. RATE AMOUNT DASDI HI FIT SIT SUTA CIT SIMPLE DEDUCTIONS NO. AMOUNT TEAR-TO 1 4 12/4 12/18 QTR. TOT. YR. TOT. Checkpoint Checkpoint DEPARTMENT OCCUPATION WORKS IN (STATE SEX 5 5. ACCOUNT NO. NAME - LAST FIRST MIDDLE F OTHER DEDUCTIONS INFORMATION SALARY WITH FILING GROUP INSURANCE UNION DUES OTHER WEEKLY RATE ALLOW. STATUS to to to to HOURLY RATE OVERTIME RATE 20 REGULAR EARNINGS OVERTIME EARNINGS CUMULATIVE DEDUCTIONS NET PAID PAYDAY EARNINGS FICA OTHER CK HRS. RATE AMOUNT RATE AMOUNT DASD HI FIT SIT SUTA CIT SIMPLE DEDUCTIONS NO AMOUNT 1 12/18 QTR. TOT. YR. TOT . Checkpoint Checkpoint