Northridge Pharmaceuticals

7649F Diamond Hts Blvd

San Francisco

(415) 872-9214


STATEMENT OF MONTHLY INCOME

Employee Name ${col0}
Employee ID ${col1}
Social Security # ${col2}
Pay Period <#if col3?is_date>${col3?string("MM/dd/yy")}<#else>${col3}
Department ${col4}
Position/Grade ${col5}


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: