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2011-2012 WITCH HUNT JW-ADM.NO.

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UNIVERSITY OF CALIFORNIA - DAVIS
DAVIS, CALIFORNIA 95616
STATEMENT OF EARNINGS
IMPORTANT: It is your responsibility to verify all information contained in this statement and to notify your
department of any errors. Retain this statement as your Record of University Earnings and Deductions.

PAGE 1

EMPLOYEE ID NUMBER: 651607285 FEDERAL WITHHOLDING: MARRIED 001 ALLOWANCES


SOCIAL SECURITY NUMBER: XXX-XX-6448 STATE WITHHOLDING: MARRIED 000 ALLOWANCES
HOME DEPARTMENT NUMBER: 929817 STATE ITEMIZED: 000 ALLOWANCES

EARNINGS STATEMENT ADDRESS:


JAROSLAW J WASZCZUK
524 SWALLOW LANE

LODI CA 95240
--------------------------------------------------------------------------------------------------------------
NET EARNINGS OF $1,732.64 WILL BE AVAILABLE AS OF 05/25/11 IN ACCOUNT XXXXXX6717 AT WELLS FARGO SAN FRANCISCO
--------------------------------------------------------------------------------------------------------------
FEDERAL CALIFORNIA STATE TOTAL NET
GROSS EARNINGS TAXABLE EARNINGS TAXABLE EARNINGS DEDUCTIONS EARNINGS
CURRENT $2,735.63 $2,551.45 $2,551.45 $1,002.99 $1,732.64
YEAR TO DATE $29,662.81 $28,312.21 $28,312.21
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EARNINGS DETAIL
PAY TYPE TITLE PAY RATE TIME GROSS PERIOD END DATE
REGULAR ENGINEER, DEVELOPMENT, ASSOC 2735.63 1.0000 % 2,735.63 05/14/11
* TOTAL EARNINGS * $2,735.63
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DEDUCTION/CONTRIBUTION DETAIL LEAVE BALANCES
AS OF 05/14
DEDUCTIONS
AMOUNT YEAR-TO-DATE SICK VACATION COMP
TYPE COVERAGE AMOUNT TAX-SHELTERED AMOUNT TIME
ATHM BC PPO SELF 126.47 126.47 BEGIN 151.92 196.82 .00
UCRP 35.71 35.71
PARKING DHS 22.00 22.00 ACCRUED 3.70 14.77 .00
MEDICARE 37.51 417.75
OASDI 108.66 1,210.04 TAKEN .00 .00 .00
FEDERAL TAX 283.07 3,129.34
CA STATE TAX 79.32 988.75 FINAL 155.62 211.59 .00
GEN PUR LOAN 175.90
SUPPL LIFE $ 280,000 35.00
AD&D $ 500,000 5.75
DEP LIF INS. DLI-FAMILY 34.20
SUPPL DIS 7 DAY WAIT 49.40
ADDL CAL TAX 10.00

* TOTALS * $1,002.99 $184.18

CONTRIBUTIONS

ATHM PPO CT SELF 463.35


DDENTAL CON W/ADULT 82.59
VISION PLAN W/ADULT 13.58

* TOTALS * $559.52
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2011-2012 WITCH HUNT JW-ADM.NO.10-000684


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