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Human Resource Services
Emma B. Lommasson
Center Room 252
The University of Montana
Missoula, MT 59812

Monday-Friday
8:00-Noon, 1:00-5:00

(406) 243-6760 JOBLINE
(406) 243-6766 OFFICE
(406) 243-6095 FAX

SAMPLE EARNINGS STATEMENT

STATE OF MONTANA
THE UNIVERSITY OF MONTANA - MISSOULA PAYROLL
VOID 180 DAYS AFTER ISSUE DATE

**DIRECT DEPOSIT ACKNOWLEDGEMENT STATEMENT - DO NOT CASH**

LOC/DEPT DATE NUMBER AMOUNT
1311 6/25/1997   ******679.09
      Six Hundred Seventy Nine & 09/100******
DEPOSITED IN THE NAME OF
EXPLANATION
of DEDUCTIONS
NOT A VALID CHECK
FOR CONFIRMATION OF DIRECT DEPOSIT ONLY

John Doe
Human Resource Services
LO 265
Missoula, MT 59812

Montana Educator's Credit Union

THIS IS A STATEMENT OF YOUR EARNINGS AND PAYROLL DEDUCTIONS. PLEASE DETACH AND RETAIN.
IDENT. NO. EMPLOYEE NAME SOCIAL SECURITY NO. PERIOD END DEPOSIT DATE DOCUMENT NO. DEPOSIT AMOUNT
010203040 Doe, John 010-20-3040 06/17/1997 06/25/1997 44945 679.09

 

DESCRIPTION OF DEDUCTIONS DEDUCTIONS CURRENT YTD
Employer Contribution (MO Flex Credit) BasicBen -245.00 -245.00
Mandatory Basic Term Life Insurance Premium for Employee BasicLif 2.80 2.80
Mandatory Dental Insurance Premium Dental 50.00 50.00
Federal Tax Withholding Fed W/H 20.00 578.14
Flex Administration Fee Flex Adm 2.75 16.50
Forfeited Flex Credit ForfCrdt .00 .00
Insurance Premium Reserve Account for 10-month Employees InsResv .00 .00
Long Term Disability Premium LTD 4.70 4.70
Health Insurance Premium (Medical/Vision) MedVis 323.10 323.10
Medicare Tax Medicare 12.57 156.86
Montana Family Education and Savings Program MTFESP .00 .00
Social Security Tax OASDI 53.76 670.72
Retirement for Staff (Employee Contribution) PERS 62.87 817.31
Retirement for Faculty (Employee Contribution) Ret-TIAA 62.87 817.31
Retirement for Faculty (Employee Contribution) TRS 62.87 817.31
Dependent Care Optional Reimbursement Account RbDepCar .00 .00
Health Care Optional Reimbursement Account RbHealth .00 .00
State Tax Withholding State W/H 16.88 287.19
Reserve for Supplemental Term Life Ins. Premium (10 mnth empl) TermLfRs .00 .00
Supplemental Term Life Insurance Premium TermLife 4.26 4.26
Supplemental Term Life Insurance Premium for Dependents TermSupp 8.20 8.20
Reserve for Supplemental Term Life Ins. Premium/Dependents (10 mo.) TermSupR .00 .00
Tax Sheltered Annuity Deduction VALIC 12.50 522.50
Optional Accidental Death and Dismemberment Premium Vol Accd 4.30 4.30
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