EFTA00187097

949 (9/79)

TRANSFER/TERMINATION

TERMINATION

EFTA00187098

<table><thead><tr><th>LOCATION</th><th colspan="2">EMP. NO.</th><th colspan="2">EMPLOYEE NAME</th><th rowspan="2">REGULAR RATE 500 | 00</th><th rowspan="2">O/T RATE 1</th><th rowspan="2">O/T RATE 2</th><th rowspan="2">SH. REG HPS.</th><th rowspan="2">O/T HRS 1</th><th rowspan="2">O/T HRS 1</th></tr><tr><th>825013000</th><th>006257</th><th>EPSTEIN J</th><th>EPSTEIN J</th></tr></thead><tbody><tr><td>THIS PAY PERIOD</td><td>GROSS 500 | 00</td><td colspan="2">FEDERAL TAX 71 | 23</td><td>FICA 29 | 25</td><td>STATE TAX 15 | 97</td><td>CITY TAX 6 | 53</td><td>SUI / DBL</td><td>DEDUCTIONS</td><td>NET PAY</td><td></td></tr><tr><td>YEAR TO DATE</td><td>GROSS 2500 | 00</td><td colspan="2">FEDERAL TAX 356 | 15</td><td>FICA 146 | 25</td><td>STATE TAX 79 | 85</td><td>CITY TAX 31 | 21</td><td></td><td>EARNINGS</td><td>AMOUNT</td><td></td></tr><tr><td>DEDUCTIONS</td><td colspan="2">AMOUNT</td><td colspan="2">DEDUCTIONS</td><td>AMOUNT</td><td colspan="2">DEDUCTIONS</td><td colspan="2">AMOUNT</td><td>5CO C</td><td></td></tr></tbody></table>

G3 15 76



NEW YORK NY 10028





BREAK CLOSE 2:37"





00431

1E700





108 EAST 89TH STREET



THE DALTON SCHOOLS INC

P. M. NO.



RETAIN THIS STATEMENT FOR YOUR RECORDS



STATEMENT OF EARNINGS

NO. 06187035