| 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: | |||
| _______________ | _______________ | _______________ | _______________ | |