Printable Business Form Templates
Payroll Statement Business Form Template

Payroll and Earnings Statement

Fields: employer, employee name, employee number, salary for the period, beginning, ending, earnings, regular hours worked, overtime hours, non cash compensation, other amounts due - commission, special allowances etc., total wages or salary, gratuity/tips received directly by the employee, total earnings, tax deductions, FICA, federal income tax withheld, state income tax withheld, less total tax deductions, net earnings after deductions, other deductions, total of all other deductions, paid in cash, check, account transfer, net amount due

I certify the correctness of the above calculations and acknowledge the receipt of the net amount due to me.

Employee's Signature __________________________ Date ___________

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