Northridge Pharmaceuticals
7649F Diamond Hts Blvd
San Francisco
(415) 872-9214
STATEMENT OF MONTHLY INCOME
Employee Name | ${col0} | Department | ${col4}
Employee ID | ${col1} | Position/Grade | ${col5}
Social Security # | ${col2} |
Pay Period <#if col3?is_date> | ${col3?date} <#else> | ${col3} |
EARNINGS | AMOUNT | TAXES/DEDUCTIONS | AMOUNT
Basic Salary | ${col6} | Federal Tax | ${col7}
Bonuses | ${col8} | Social Security Tax | ${col9}
|  | Medicare Tax | ${col10}
|  | State Tax | ${col11}
|  | Medical | ${col12}
|  | Dental | ${col13}
Total Earnings | ${col14} | Total Deductions | ${col15}
| Net Pay | ${col16}
Employee signature: | Director:
_______________ | _______________ | _______________ | _______________