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CO. FILE DEPT. CLOCK VCHR. NO.

U49 062682 71WFF6 0000050626 1


Earnings Statement
626-0001
OMAHA STEAKS INT’L Period Beginning: 01/17/2021
11030 O STREET Period Ending: 01/30/2021
OMAHA, NEBRASKA 68137 Pay Date: 02/05/2021

RYAN GENE BAKER


Filing Status: Single/Married filing separately 6322 RUGGLES ST
Exemptions/Allowances:
Federal: Standard Withholding Table
OMAHA NE 68104

rate hours this period year to date


Reg Wk1 13 0000 40 00 520 00 1 535 00 BASIS OF PAY: HOURLY
Reg Wk2 13 0000 33 50 435 50 1 398 00
Bonus Wk2 1 011 00
Taxable Marital Status:
Diff Wk1 21 65 NE: Single
Holiday Wk1 150 00 Exemptions/Allowances:
Holiday 2 150 00 NE: 0
Ot Comm 1 63 53
Ot Wk 1 628 50
Ot Wk2 310 13
Gross Pay $955 50 5 267 81

Statutory
Federal Income Tax -49 07 536 48
Social Security Tax -59 24 326 60
Medicare Tax -13 85 76 38
NE State Income Tax -30 74 231 09

Net Pay $802 60


Owner Checking -802 60

Net Check $0 00

Your federal taxable wages this period are $955 50

2000 A DP, LLC

OMAHA STEAKS INT’L Advice number: 00000050626


11030 O STREET Pay date: 02/05/2021
OMAHA NEBRASKA 68137

Deposited to the account of account number transit ABA amount


RYAN GENE BAKER xxxxx7764 xxxx xxxx $802 60

NON-NEGOTIABLE

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