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County Office of Education Earnings and Leave Statement
| EMPLOYEE NAME/ID NUMBER | FED | STATE | PAY CALENDER | PERIOD END | ISSUE DATE | WARRANT NUMBER | ||
| M4 | M4 | CECONT | 378961 | |||||
| DISTRICT/PAY LOCATION | CONTACT: | LEAVE BALANCE | ||||||
| 99-MY SCHOOL DISTRICT 09-SCHOOL SITE |
PAYROLL (831) 555-1234 |
SICK 10.00 |
PER BUS . |
PER NECES . |
VAC . |
AS OF 10/31/08 |
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| GROSS EARNINGS | ||||
| TYPE | UNIT | NO UNITS | RATE | EARNINGS |
| NML BILN DOCT MAST CASH . . . . . . |
. . . . . . . . . . . |
. . . . . . . . . . . |
. . . . . . . . . . . |
8,581.03 100.00 83.33 83.33 36.10 . . . . . . |
| TOTAL 8883.79 | ||||
| DESCRIPTION | CURRENT | YEAR TO DATE | |
| *GROSS PAY TAX SHELTER SECTION 125/CAFETERIA PLAN STRS RETIREMENT TAXABLE GROSS FEDERAL INCOME TAX ADD'L FEDERAL INCOME TAX STATE INCOME TAX MEDICARE TAX **NETPAY** . |
0.00 100.00 826.87 7,956.92 150.00 0.00 . |
1,400.00 800.00 6,665.36 62,834.96 0.00 . |
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| WARNINGS | ||||
| TB Test Expires 10/30/2010. Contract your District HR immedaitely. . |
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| MESSAGES AND NOTES | ||||
| Credential(s) to expire within 90 days Renew online at WWW.CTC.CA.GOV Please check your address and contact yourHR dept to correct. FOR HELP READING THE NEW PAYSTUB GO TO www.infotech.santacruz.k12.ca.us/readpaystub |
| DEDUCTIONS/CONTRIBUTIONS | EMPLOYEE | EMPLOYER | |
| AM FID s125 MEDICAL REIMB ACCT MEDICAL INSURANCE ADDITIONAL STRS - PU REPAYMENT . . . . . . . |
100.00 . 116.17 . . . . . . . |
0.38 975.74 0.38 . . . . . . . |
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| TOTAL | 216.17 | 975.74 | |
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| Form 1099-MISC CORRECTED(if checked) (keep for your records) | ||||
PAYER'S name,street address,city,state,ZIP code, and telephone no.
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1. Rents . $ |
DMB No. 1545-0115 . 2011 . Form 1099-MISC |
. Miscellaneous Income . 38-2099803 Department of the Treasury -- IRS |
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| 2. Royalities . $ |
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| 3. Other income $ . |
4. Fed. Inc. tax withheld $ . |
Copy B For Recipent |
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| PAYER'S federal identification number . 12-1234567 |
RECIPIENT'S identification number . 444-44-4444 |
5. Fishing boat procedes . $ |
6. Medical and health care payments . $ |
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RECIPIENT'S name,address,and ZIP code.
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7. Nonemployee compensation . 650.00 |
8. Substitute payments in or interest . $ |
This is important tax information and is being furnished to the Internal Revenue Service. If you are required ti file a return, a negligence panelty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. |
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| 9. Payer made direct sale of $5000 or more of consumer products to a buyer(recipients) for resale. » $ . |
10. Crop insurance proceeds . $ |
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| 11. . |
10. . |
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| Account number (see instructions) . |
13. Excess golden parachute payments . $ |
14. Gross proceeds paid to an attorney . $ |
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| 15a. Section 409a deferrals . $ |
15b. Section 409b income . $ |
16. State tax withheld $ $ |
17. State/Payer's state no. 12-1234567 . |
18. State income $ $ |


