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	${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:
_______________	_______________	_______________	_______________