Kentucky Laborers - Contractors Deposits

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Kentucky Laborers Contractors Deposits PAGE 1 3/3/2017 # Local Contractor H & W Training KY LECET Regl LECET / Trifunds Local 576 Working Dues Assessment: District Coun 1 1445 ADVANCED VETERNARY SVC 3,17100 2 189 HNKLE CONSTRUCTON SVC 2,34215 15165 10784 1348 30249 7562 3 1392 PCL CVL 17290 4 1392 PCL CVL 21916 5 1392 PCL CVL 28390 6 1392 PCL CVL 13960 7 576 ASSOCATED RALROAD NO WORK Total Daily Deposits 6,32871 15165 10784 1348 30249 7562

Kentucky Laborers Contractors Deposits # 1 2 3 4 5 6 7 Contractor Local 576 Add'l Working Dues: Total ADVANCED VETERNARY SVC 3,17100 HNKLE CONSTRUCTON SVC 6740 3370 1685 1685 3,12803 PCL CVL 17290 PCL CVL 21916 PCL CVL 28390 PCL CVL 13960 ASSOCATED RALROAD Total Daily Deposits 6740 3370 1685 1685 7,11459 District Coun KY LPL 189 Drug & Safety 1445 Drug & Safety 1445 BTD & Cap 576 Const Drug Test OTHER

KENTUCKY LABORERS CONTRACTORS DEPOSTS CONTRACTOR: ADVANCED VETERNARY SVC DEPOST DATE: 3/3/2017 LOCAL# 1445 REPORT DATE: CHECK AMOUNT: Mar17 3171 HOURS REPrD: Federal Tax D#: 61 1185349 CHECK NUMBER: 31293 GROSS WAGES: PREPARED BY: RHONDA HOOVER ANDERSON RECEVED DATE: 3/1/2017 DATE PREPARED: 3/2/2017 RATE AMT ON REPT DFFERENCE REMARKS Health & Welfare 3, 17100 Training KY LECET Reg' LECET TriFunds 'i Working Dues: 4% LocaV1% KLDC of Gross Wages Local 576 District Council Add'/ Working Dues: 20 Loca/110 KLDC xhrsworked Local576 ; District Council KY LPL 189 Drug & Safety 1445 Drug & Safety 1445 STD & Cap 1"1'11392 576 Const Drug Test PACAF nd' = 'TOTALS: 53,111ool soool

::>ep ur 16 10:14a Jackson Brothers 6066380427 p1 KENTUCKY LABORERS' DSTRCT COUNCL PENSON & WORK DUES MONTHLY EMPLOYER REMTTANCE REPORT (Stationary Units Only) REPORT FOR THE MONTH OF:,_ m+, tjjrt L Due date is the (10th) day of the month following the work month FEDERAL TAX D: (ul J _53yq EMPLOYERS NAME; Ad'lltl:wi Jcnl\4ik\ JU J EMPLOYERS ADDRESS: 3101, laul J '4 H :i 2 J EM::PLOYERS PHONE #: &Q 3Jt 7Wo EMJ>LOYEES # SOCAL SECURTY NUMBER l 1gq_ 2 (o'/61 2 11G7 2Ji 3 13 4 ' f 4o' 1';J D?JS7 CONTRBUTONS OWED: = W1_1KK G DUES: o of Grnss Wages= CERTFED BY: WORK PERFORMED N THE JURSDCilON OF: (Circle One) (l\ 1 Q '2) 576 (3)1214 (4) 1392 (5) 1445\') EMPLOYEES Ni\ME Va HW1 U ty"" u An Da µ WtdW 1rf} Rnx LJ } FOR AUDT ONLY: SEND PENSON TO: Laborers' National Pension Fund PO Box803415 Dallas, Texas 753803415 SEND WORKNG D\J""ES TO: Laborers' Local Union i having jurisdiction where work is perfonned MO HOURS WORKED loo l D J o GROSS WAGES /3)tS:W 1"3 1 c::;,lp 2 Uu O 4 CfJW 5 ' 0 ) 6 ' 7 i/j "' ro v lf1 3 N A ve<, il1u<lo 8 3 qo thrl( (i1 (1 TOTALS : jq l8'3 r?

Sep07_1610:14a Jackson Brothers VVVVYVV"'T:r KEl'lTUCKY LABORERS, DSTUCt COUNCL PENSON & WORKDUES FEDERAL TAX D: Jlf5349 E\fPW):"'"ERS NAME; MONTlLY El\fPLOYER REMTTANCE REPORT (Stattonru Units Only) t> u _A J v ll t'll1!! \} (JJ<,:,, r\/j"\ vlu J EMPLOYERS ADDRESS: 3 1ut3 JU r:\la ::> \l \ 2 REPORT FOR TBE MONTH OF: «) Due date is the (10tli) day of tbe month following tbe wotk montb CONUUBUTONS OWED:, ' SlON: W J t< K rnig DUES: :ryo ofgfoss Wages= CERTFED BY: 61,j cy' FOR ATDT ONLY: SEND PENSON TO: Laborers' N ()nal Pension Fund PO Box803415 Dallas, Texas 753803415 EMJ>LOYERS PHONE#: 'VORK PERFORMED N THE SEND WORKNG DUES JURSDCTON OF: TO: Laborers' Local Union tlfu 3'1Y2JJ'O (Circle One) 1 having jurisdiction where woik EMPLOYEES " # soci;al SECURTY l'iljmber 1 1gq_ 2 lti Ji1 2 27 & 7 {,,, 1Uq3 (1\ 1Q 576 (3)1214 (4) 1392 ( ) 1445 EMPLOYEES NAME Vtdie(!{ b iy" u /hi D{wiµ 1\ttA is performed_ BO URS WORKED Mo GROSS WAGES 1o o J311s\w r&v l'3 is, io! 3, 402'1'/J, D'OS/ rfh:aj ijn Rn k s4j j f) 1 Z,(p CJ J'O 4 '"U 4 q 1 "tp 5 6 7 8 o ro "Nu A av 3 ::,qo PJtZ /,o l,, l/1 x3 t 110 oo t ( (7:1 l1 1 TOT S: jo,(o18'3' J

Sep071610:14a Jackson Brothers vvvvvvvr:r KENTUCKY LABORERS, DSTRlCt COUNCL PENSJON & WORKDUES MONTHLY EMPLOYER RE!"flTTANCE REPORT (Stationruy Uruts Only) ;y\v REPORT FOR '1lE J\fONTH OF: {() taf1l 6(J Due date is the (10tli) day of tbc month followjog the work month FEDERAL TAX D: CONTRBUTONS OWED: FOR ATDT ONLY: ( 1 J f53'icf E\fPWYERS NAME: _Adv1lt'lw1 \/eknmta\ "'' ) ) ::::::: SlON: Wt111' u NG DUES: of Gross Wages = 3 i3 J CERTFED BY: SEND PENSON TO: EMPLOYERS ADDRESS: rc1 =7 \ l EMPLOYERS PHONE#: {2fur 3'1 r 251 : WORK PERFORMED N THE JUlUSDCilON OF: (Circle One) (T\ 10 576 (3)1214 (4) 1392 (5) 1 445 EMPLOYEES ' # socl;al SECURTY l'iljmber EMPLOYEES NAME 1 1J?l1 <J; {nij6} Va lie D iy T, 2 21 7 l 2JJ'13? W:, j)t'wiaj! 3 f 4 5 4a2'b ocos 7 ""' }iirtakt/ ''" J Laborers' National Pension Fund PO BOh 80341 S Dallas, Texas 753803415 SEND WORKNG D13ES TO: Laborers Local Uruon 1 having jurisdiction wheno work is perfonncd RO URS WORKED Mo GROSS WAGES J lo 0 i3jl':;,io r v l "3 c:;?,o rfh:aj Jl1<A Rn ks }14) 0 1 7A,; c'j J'O 7 u q C,JW 4' a ' " 0 " ),, 6, CJl V :i_ 7 1 TOTAL: NbAtlli j (10 oo 8 3 :,qo P fh ( (z1 (1 jo_&1 3