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Home My WebLink About20220928130714610 U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whdlformslwh347instr.htm) Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. NAME OF CONTRACTOR' OR SUBCONTRACTOR_ ADDRESS 769 Pinto Circle OMB No.: White Rock Construction Inc. Gardnerville NV 89410 Expires: PAYROLL NO. FOR WEEK ENDING PROJECTAND LOCATION PROJECT OR CONTRACT NO. Keller Heavenly 3 7 9/241202212:00:00 AM 1275 Meadow Crest Drive South Lake Tahoe CA (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8)DEDUCTIONS i (9) Sun Mon Tue 'Wed Thu Fri Sat GROSS NAME AND INDIVIDUAL IDENTIFYING NO.OF 18 191 20 21 22 23 24 AMOUNT FEDERAL STATE 1 NET NUMBER(e.g.,LAST FOUR DIGITS OF W/H OT EARNED WITH- WITH- WAGES SOCIAL ISECURITY NUMBER)OF EXEMP WORK OR TOTAL RATE PROJECT HOLDING ;HOLDING TOTAL PAID ,I WORKER TIONS CLASSIFICATION ST HOURS WORKED EACH DAY HOURS OF PAY /PERIOD FICA TAX TAX i MEDICARE OTHER DEDUCTIONS FOR WEEK Eduardo A Acevedo 1 1000 0 1.00 1.00 80.17 _1_,4_8_7.32 PO Box425 GLP S 6.50 8.00 8.00 22.50 62.54 1,487.32 92.21 188.13 71.10 21.57 16.36 389.37 1,097.95 Rincon PR 00677 Dwight E Bolton 1 1000 0 2.25 3.00 1.00 3.25 2.50 12.00 88.20 _3,835.15 759 Hornet Drive TE S 8.00 8.00 8.00 8.00 8.00 40.00 69.42 3,835.15 237.78 565.58 253.33 55.61 42.19 1,154A9 2,680.66 Gardnerville NV 89460 German Franco 1 1000 0 1.00 1.00 80.17 __1,33_0._97 141 Kramer Court GLP S 1.00 7.00 8.00 4.00 20.00 62.54 1,665.65 103.27 334.05 43.48 24.15 18.32 523.27 1,142.38 Dayton NV 89403 German Franco 1 1000 0 334.68 SL4 S 4.00 4.00 83.67 Richard A Jacobson 1 1000 0 1.001 1.00 80.17 1,330.97 P.O.Box 8720 GLP S 5.50 8.00 6.50 20.00 62.54 1,330.97 82.52 153.74 60.57 19.30 14.64 330.77 1,000.20 South Lake Tahoe CA 96158 Alejandro C Martinez 1 1000 0 _ 1,344.61 P.O.Box 13063 GLP S 6.50 8.00 7.00 21.50 62.54 1,344.61 83.37 60.59 61.96 19.50 14.79 240.21 1,104A0 South Lake Tahoe CA 96151 Leslie McCrosky 0 1000 0 1.00 1.00 115.10 _2,569.02 897 Sprinq Valley Road EX3 5 5.00 7.00 8.00 8.00 28.00 87.64 2,569.02 159.28 341.61 126.54 37.25 28.26 692.94 1,876.08 Gardnerville NV 89410 Steven Nieves Badillo 0 1000 0 1.00 1.00 80.17 _1,518.59 BO:Rio Grande HC 57 GLP S 7.00 8.00 8.00 23.00 62.54 1,518.59 94.15 231.40 82.49 22.02 16.70 446.76 1,071.83 Box 9042 Aquada PR 00602 Richard R Nieves Sanchez 1 1000 0 1.00 1.00 80.17 1,518.59 HC57 Box 9042 GLP S 7.00 8.00 8.00 23.00 62.54 1,518.59 94.15 195.01 79.76 22.02 16.70 407.64 1,110.95 Aquada PR 00602 Matthew Norbem 0 1000 0 0.50 2.50 3.00 115.10 _2,711.57 1517 Gilman Avenue EX3 S 3.00 8.00 8.00 8.00 27.00 87.64 2,711.57 168.12 372.97 141.12 39.32 29.83 751.36 1,960.21 Gardnerville NV 89410 Gerald S Rousseau III 1 1000 0 1.00 1.00 80.171 1,487.32 727 Bluerock Road GLP S 6.50 8.00 8.00 22.50 62.54 1,487.32 92.21 229.34 76.56 21.57 16.36 436.04 1,051.28