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Sample Leave and Earnings Statement

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<<Payroll Specialist, Formal Title>> <<Address Line 1>> <<Address Line 2>> <<Address Line 3>> <<City>>, <<State.>> <<ZIP>> NET PAY $ 963.06 TO: BANK ABA #: 102000076

LEAVE AND EARNINGS STATEMENT

PAY PERIOD: 04 ENDING DATE: 2000-02-12 PAGE 1 OF 1

SMITH, JOHN 1234 ANY STREET BALTIMORE

MD 21201

EMPLOYEE IS RESPONSIBLE FOR VERIFICATION OF PAY, DEDUCTIONS, AND LEAVE.

CURRENT P/P HRS AMOUNT ADJUSTMENTS HRS AMOUNT TOTAL YTD

EARNINGS/OTHER PAY REG $ 16.90 PH OVT $ 16.90 PH FLSA PREM GROSS PAY

=========================================================================================================

80.00 12.00 12.00 $1352.00 $202.80 $101.41 $1656.21

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***DESCRIPTION***

***BASIC INFORMATION***

$5774.48

DEDUCTIONS RETIREMENT CSRS 7.000% MEDICARE 1.450% FEDERAL TAXES MARRIED/4 EXEMPT/0 EXTRA STATE TAXES MD MARRIED/4 EXEMPT/0 EXTRA HLTH INS 105 BOND UNION CHARITY DISCRET ALLOT SAVINGS ALLOT 999888777 THRIFT LOAN 9612345-Z TSP. FUND TOTAL DEDUCTIONS

$94.64 $24.02 $144.86 $103.57 $56.58 $15.00 $6.00 $1.00 $25.00 $158.00 $37.44 $27.04 $693.15

$376.26 $83.73 $453.13 $348.70

SSN PAY- PLN/GR/ST SALARY - (PA) SCD (LEAVE) FLSA CLASS CUM RET AGENC TSP (AMT/PTC) CAN#:

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XXX-XX-6789 GS/08/07 $35261 75- 01-02 NON-EXEMPT $55616.28 2% 4000113

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$219.77 $60.00 $24.00 $4.00 $100.00

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**YTD TAXABLE EARNINGS** ============================ FEDERAL $5666.98 STATE MD $5666.98 *******SAVINGS BONDS ******** NO ISSUED P/P BALANCE ============================ 1 $22.50 2 $22.50 3 100.00

$107.50 $1777.09

***AGENCY CONTRIBUTIONS*** ITEM P/P YTD ================================= CSR REGULAR $115.06 $454.44 MEDICARE $24.02 $83.73 HLTH INS $142.27 $561.75

**CHECK

MAILING

ADDRESS**

***W-2 MAILING 1234 ANY STREET BALTIMORE

ADDRESS*** MD 21201

LEAVE CAT LVYR ACCRD USD BAL PROJ MAX USE / TYPE (8) C/0 ADJ PP YTD PP YTD ADV AVAIL YR END C/O LOSE ======================================================================================================================= ANN 240.00 8.00 24.00 9.00 27.00 237.00 184.00 240.00 181.00 SICK 468.45 4.00 12.00 9.00 9.00 471.45 CREDIT 1.00 + ! & ' ! ' *"*, 5 RST AN 16.00 54.00 ' !( < ' @5 < * *( ADMIN 1.15 REL CT 8.00 -8.00 + ! $ - '! 3 # + -' ! ! '

REMARKS/MESSAGES: PAY/LEAVE QUESTIONS? CALL PAYROLL HOTLINE (303) 969-7732; FROM HOME 1-800-662-4324

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