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CITIZENS BANK
5-7017/2110

Friendlys Ice Cream LLC
1855 Boston Road
Wilbraham, MA 01095

Check Date
April 29, 2016

Check Number
623610
PAYROLL CHECK

Pay this
amount:

One hundred ninety-eight dollars and twenty-two cents *****************

******** 198.22
VOID AFTER 180 DAYS

To the B4399 100-1213-51100
order of MICHAEL BROWN

169886 623610 489791

89

Non
Negotiable - This is not a check - Non Negotiable
10 CHURCH PLACE
WETHERSFIELD, CT 06109

Authorized Signature

C00623610C A000000000A 000000000C
Friendlys Ice Cream LLC
MICHAEL BROWN
Employee ID
Location

Earnings Statement

169886
100-1213-51100

Fed Taxable Income
Fed Filing Status
State Filing Status

382.15
S-0
F-0

Check Date
April 29, 2016
Period Beginning April 11, 2016
Period Ending
April 24, 2016

Week of 04/11/2016 to 04/17/2016
Earnings
Rate
REGULAR PA
6.07

Hours
5.03

Amount
30.53

Deductions
FESIP PRETAX CONTRIB
TIP CREDIT
Deductions

Week of 04/18/2016 to 04/24/2016
Earnings
Rate
REGULAR PA
6.07
RATE 2
9.60
RATE 3
9.60
TIP CREDIT

Hours
30.25
4.52
0.82
0.00

Amount
183.62
43.39
7.87
124.54

Taxes
CT
FITW
MED
SS
Taxes

40.62

389.95

YTD Hours
441.11
4.52
14.00
0.00
459.63

YTD
2,677.54
43.39
134.40
1,557.11
4,412.44

Gross Earnings (2 weeks)
Year-to-Date Earnings
Earnings
REGULAR PA
RATE 2
RATE 3
TIP CREDIT
Total Year-to-Date

Rate
6.07
9.60
9.60

EMPLOYEE DISCOUNT 15%

MICHAEL BROWN

Filing Status
F-0
S-0

Direct Deposits Type

Check Number
Net Pay
Check Amount

623610
198.22
198.22

Amount
7.80
124.54
132.34

YTD
88.25
1,557.11
1,645.36
Amount
0.00
29.56
5.65
24.18
59.39

Account

YTD
0.47
388.70
63.97
273.57
726.71
Amount

No Direct Deposits

Check Date: April 29, 2016

Show this portion of your paycheck stub along with a photo ID and receive your EMPLOYEE DISCOUNT, good for 15% off the total
check! This stub will expire 14 days from this check date. This offer is valid in ALL FRIENDLY'S company operated restaurants.
Friendlys Ice Cream LLC | 1855 Boston Road Wilbraham, MA 01095 | (413) 731-4255


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