Decatur Store

**** * ************ ********** (PCSUVO)

Earnings Statement

**/**/****

LOVE’S TRAVEL STOPS & COUNTRY STORE

Empl ID 000333736

333-***-****

***** * ************ ***.

Page 001 of 001

OKLAHOMA CITY OK 73120

Period Beg/End: 12/29/2021

01/10/2022

0746: Decatur, Il

-

375.96

For inquiries on this statement please call: 405-***-**** Advice Date: 01/10/2022

Total Hours Worked: 27.55

Advice Number: 333-***-****

Basis of Pay: Hourly

Batch Number: 000*********

Pay Rate: 13.20

TERRILL BOND

Your Federal taxable wages for this period are: $407.10 3972 N CONSTANT VIEW APT 5

YTD Federal taxable wages are :$688.26

DECATUR, IL 62526

CO

Net Pay 375.96

PCSHV2

Earnings Rate Hours Current YTD Amount

Direct Deposit Summary

Regular 13.20 27.55 363.67 644.83

XXXXXX1473 375.96

HolPay50 6.60 6.58 43.43 43.43

Advice Number:

Gross Pay 407.10 688.26

Advice Date:

XXXXXX1473 264171241

Tax Deductions

Checking

Social Security Tax 25.24 42.67

Medicare Tax 5.90 9.98

Total Tax Ded. 31.14 52.65

LOVE’S TRAVEL STOPS & COUNTRY STORE

10601 N Pennsylvania Ave.

OKLAHOMA CITY OK 73120

TERRILL BOND

000***-******

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