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20221025164519938
U.S. Department of Labor PAYROLL Wage and Hour Division (For Contractor's Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.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 PROJECTOR CONTRACT NO. Keller Heavenly 3 10 10/15/2022 12:00:00 AM 1275 Meadow Crest Drive South Lake Tahoe CA (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8)DEDUCTIONS (9) Sun Mon' Tue Wed Thu Fri Sat GROSS NAME AND INDIVIDUAL IDENTIFYING NO.OF 9 10 11 12 13 14 15 AMOUNT FEDERAL STATE NET NUMBER(e.g.,LAST FOUR DIGITS OF W/H OT EARNED WITH- WITH- WAGES SOCIAL SECURITY NUMBER)OF EXEMP WORK OR TOTAL RATE PROJECT HOLDING HOLDING TOTAL PAID WORKER TIONS CLASSIFICATION ST HOURS WORKED EACH DAY HOURS OF PAY /PERIOD FICA TAX TAX MEDICARE OTHER DEDUCTIONS FOR WEEK Eduardo A Acevedo 1 1000 0 1.00 1.00 2.00 80.17 _2,661._94 PO Box 425 GLP S 8.00 8.00 8.00 8.00 8.00 40.00 62.54 2,661.94 165.04 460.55 191.27 38.60 29.28 884.74 1,777.20 Rincon PR 00677 Dwiqht E Bolton 1 1000 0 1.75 4.25 1.50 1.50 1.00 10.00 88.20 _3,658.75 759 Hornet Drive TE S 8.00 8.00 8.00 8.00 8.00 40.00 69.42 3,658.75 226.84 526.77 235.29 53.05 40.25 1,082.20 2,576.55 Gardnerville NV 89460 German Franco 1 1000 0 1.00 1.00 2.00 80.17 _2,661.94 1080 Centerville Road GLP S 8.00 8.00 8.00 8.00 8.00 40.00 62.54 2,661.94 165.04 573.16 127.85 38.60 29.28 933.93 1,728.01 Gardnerville NV 89460 Richard A Jacobson 1 1000 0 1.00 1.00 2.00 80.17 _2,661.94 P.O.Box 8720 GLP S 8.00 8.00 8.00 8.00 8.00 40.00 62.54 2,661.94 165.04 460.55 196.73 38.60 29.28 890.20 1,771.74 South Lake Tahoe CA 96158 Aleiandro C Martinez 1 1000 0 1.00 1 1.001 2.00 80.17 _2,661.94 P.O.Box 13063 GLP S 8.00 8.00 8.00 8.00 8.00 40.00 62.54 2,661.94 165.04 364.40 196.73 38.60 29.28 794.05 1,867.89 South Lake Tahoe CA 96151 Leslie McCroskv 0 1000 0 1.00 1.00 1.00 1.00 4.00 11S.10 _3,966.00 897 Sorinq Valley Road EX3 S 8.00 8.00 8.00 8.00 8.00 40.00 87.64 3,966.00 245.89 654.74 269.45 57.51 43.63 1,271.22 2,694.78 Gardnerville NV 89410 Steven Nieves Badillo 0 1000 0 1.00 1.00 2.00 80.17 _2,661.94 BO:Rio Grande HC 57 GLP S 8.00 8.00 8.00 8.00 8.00 40.00 62.54 2,661.94 165.04 500.24 199.45 38.60 29.28 932,61 1,729,33 Box 9042 Aquada PR 00602 Richard R Nieves Sanchez 1 1000 0 1.00 1.00 2.00 80.17 _2,661._94 HC57 Box 9042 GLP S 8.00 1 8.00 1 8.00 8.00 8.00 40.00 1 62.54 2,661.94 165.04 460.55 196.73 38.60 29.28 890.20 1,771.74 Aquada PR 00602 Matthew Norberq 0 1000 0 701.12 1517 Gilman Avenue EX3 S 8.00 8.00 87.64 701.12 43.47 46.23 9.45 10A7 7.71 117.03 584.09 Gardnerville NV 89410 Gerald S Rousseau III 1 1000 0 1.00 1.00 1 2.00 80.17 _2,161.62 727 Bluerock Road GLP S 8.00 8.00 8.00 8.00 32.00 62.54 2,161.62 134.02 423.33 145.54 31.34 23.78 758.01 1,403.61