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NAME
CLOCK NO.
[
""""
ADDRESS
AGE
DEPT.
m
Section
Subsections
10
50
r
30
YEAR
ItJ~G
TAX CLASSIF'ICATION
/11-2
/.5.38t.1A·1
to. (/(/
~P.I
20. CJOC: t/.
DEPT. (2)
Page
11
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REASON
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I
1-----1f---+--_11--t----t---IIFOURTH
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1
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TOTAL
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HOURS
RATE
1
1/4
I
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7
4rl1
t(lr
1~/z~
I~ 2/11
I~
2/5
6
3/1/
7
1
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B
1 -
9
1 -
10
-
11
, -
12
: -
13
-
QTR.
7flf.J8
14
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15
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16
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1 -
19
6/3
1 -
20
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1 -
7//
21
1 -
22
1 -
23
1 -
24
1 -
25
-
26
-
OTR.
~ll.a
W-2
EARNINGS
REG. RATE
OVERTIME
OTHERS
TOTAL
7t?23
19~5
J5MV.s
1311 I1tJt:J
7~f2~
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76fZ3
769?3
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-0-
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DEDUCTIONS
AMOUNT
CHECK
F. O. A. 8.
WITHHOLDING
A
B
C
0
OF CHECK
NUMBER
TAX
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