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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
36 4115/202312:00:00 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 AMOUNT FEDERAL STATE NET
NUMBER(e.g.,LAST FOUR DIGITS OF W/H OT 9 10 11 12 13 14 15 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
Dwight E Bolton 1 1000 0 3.00 4.00 7.00 109.14 _1,266.00
759 Hornet Drive C50 S 6.00 6.00 83.67 4,341.23 269.16 660.20 293.56 62.95 39.07 1,324.94 3,016.29
Gardnerville NV 89460
Dwight E Bolton 1 1000 0 2.50 1.50 4.00 0.50 8.50 88.20 3,075.23
T3 S 8.00 8.00 2.00 8.00 7.50 33.50 69.42
German Franco 1 1000 0 1 1.501 1 1.50 109.14 _1,837.11
1080 Centerville Road CSO S 4.00 8.00 3.00 5.00 20.00 83.67 4,247.13 263.32 1,017.01 278.01 61.58 38.22 1,658.14 2,588.99
Gardnerville NV 89460
German Franco 1 1000 0 1.S0 1.501 79.79 119.69
GL3 5
German Franco 1 1000 0 1.50 2.00 1.50 5.00 113.03 2,290.33
L0928 5 4.00 5.00 8.00 3.00 20.00 86.26
Doug Hendon 0 1000 0 1,402.24
PO Box 54 EX3 S 8.00 8.00 16.00 87.64 1,402.24 86.94 241.11 64.54 20.33 12.62 425.54 976.70
Wellinqton NV 89444
Alejandro C Martinez 1 1000 0 _ 836.70
P.O.Box 13063 CSO 5 5.00 5.00 10.00 83.67 3,121.86 193.56 462.25 237.49 45.27 28.10 966.67 2,155.19
South Lake Tahoe CA 96151
Alejandro C Martinez 1 1000 0 1.50 1.50 2.00 1.00 6.00 79.79 2,285A6
GL3 S 8.00 3.00 7.00 3.00 8.00 29.00 62.29
Leslie McCrosky 0 1000 0 2.00 1 1 2.00 109.14 _ 218.28
897 Sprinq Valley Road CSO F
4,419.04 273.98 738A2 304.48 64.08 39.77 1,420.73 2,998.31
Gardnerville NV 89410
Leslie McCrosky 0 1000 0 1.50 2.00 1.50 5.00 115.09 4,081.07
EX3 5 8.00 8.00 8.00 8.00 8.00 40.00 87.64
Leslie McCrosky 0 1000 0 1 1.50 1.50 79.79 119.69
--------
GL3 5
Gerald S Rousseau III 1 1000 0 _ 167.34
727 Bluerock Road C50 S 2.00 2.00 83.67 2,727.26 169.09 599.23 197.13 39.55 277.70 1,282.70 1,444.56
Gardnerville NV 89460
Gerald S Rousseau III 1 1000 0 2.00 2.00 79.79 1,031.64
GL3 S 5.00 5.00 4.00 14.00 62.29
Gerald S Rousseau III 1 1000 0 1.00 1 1.001 80.17 924.46
GLP 1 5 1 1 5.501 8.001 1 1 1 13.50 62.54
Gerald S Rousseau III I 1 11000 0 1 603.82
been Pa,d,urw
asc
NETS ARE pA1D IN CPS above referenced tyke appti ablco tracto
b fRI�GE 8E of n,echari,c 1,u lr\not less tha e bene,ts as M 0 \fisted to the
(, Sach laborer aYr0t1 an a the reQWred frin9
in,cated on1U e e amount 4�c)below.
wage rate Poted in Section
except as �p1�,,NA`t1O�
Title) GETONS
0 Secre a �c)
Date 4,L me of S,gnatov parw) b CEpT1QN CCRpFT)
i C s �Na persons employed Y EX
I Katie M st8te: t of the
do hereby aymen actor)on the
ervise the P bcon� n °n
(1)That 1 pay°ruction In .�QOntract°r°r �rin9�'e Pad°11 Period COMM,have be\n°a1ddthecy to or
n t d on said Pro). er directy
ck f M
�O °rk)i tha
,0,te R W
�guddin9°r °rts emPloY will be made et
i1 r\A v nl all Perhave been or
K and ending mat no f s made ewer
aial Q33 Wages earned, r S bc0ntractor� shave been 1e dedu ,ons
`"e behalf of sa'd ,contra ° u at no deduce`man Permis abor ender the
on ck Ds `0n In by any peed bynan pers°ed byoe 5ecr S a 35j J 40 ty.5�.
Wh, Ro we0V'Namthefu1 29 R5es e es ea u �tAI0g,7�Stat 967,76
m th or-\ndire6l f rt3 l 9 63
fad ectry
m Re9uamended(4s Stat•
as defin d Act,acribed below:
Copelan des
3I45)1 and
^-�" RtiMARKS.
e
S,bMfitted for the ae otherem
ntTact re(Ore°dQo be
mec a�at,on fine rporm With o
erNise under tb\She rates fOl any ,ageaeceor mechanic can
that any ane ,T,p\qedL be wage rates come ed for each lab fide f,
in a bona Bureau of StGNARE
per.\0dare cO t less than e glass f cab0ns set f0'�h re9\sCered by the encl j�
erlod are du1 encY rec°9nizeeco9nized a9 ��// OVZ
are no tract that ed• the above P t,cesh. ag i1 n0 such t}riited States E As S�onoN 231 of
the con he Peorm emPtoyed in Tate aPPren of Labor,Of dTranln9' E ANo�nE suBSECT�'E 1s AN°SE
the`"orkthat any aPpream re9 s e ed 1S�te au o APprent cesh'p an NAN McQrOS\ Bove STA SEE SEc�ON'0010F nTL
Katie
ht P ttP S Secretarl OF ANY OF L PROSEGUZ,ON
(3) tces p ro9Trainin9 with ,eB pRO� M
appren S,F,°ATtON GRimtNA
APprent.e Spa ana e re915teed ?VADS, AL cNtL°R pe.
OR
NS' listed in THE WILLFUL TORTO STATES co
eXxsts in Labor. S ARE PAIO'TO APPRO��O P� me�� act have t SSE°N of°ni UN
��o
n,ent°f Dyer°r 1
OePart at: rates Paid t0 eal \b ted M tem.IoNlees,eXceP
(4) (a)W�SRE Ft�NGE e basic hourly e of{r\VN b he be efit of such
In adO,jea1efereo d pvl o%OP
Program fo
the or wQ1 be made to below.
asen°ted m SeOn 4(