[Marguerite C. Oswald v. King Candy Company] (9 of 17)

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EMPLOYER'S WAGE STATEMENT
ENG
INDUSTRIAL ACCIDENT DOARD
NOTE: PLEASE COMPLETE THIS STATEMENT IN DETAIL AND RETURN MITINAL TO THIS OFFICE
AUSTIN, TEXAS
PROMPTLY.
SHOW NUMBER OF DAYS WORKED AND AMOUNT EARNED
PERIOD COVERED
5 $
ED
WAGE RATE
BY EACH PAYMENT
OCCUPATION
(BY NOUR
AMOUNT
STATEMENT OF TOTAL EARNINGS OF
FROM
TO
(TYPE or WORK)
DAY. WEEK
EARNED
MONTH
3
OR MONTN)
Marguerite C. Uswald
MONTH
DAY
DAY
SOCIAL SECURITY NO.
1
8
28
8
31
Sales
175.00 ma
26125
435-2:-5686
2
9
1
9
30
II
"
"
180,00
1
"
"
"
FROM
TO
3
10
10
31
175.00
Auguso F., 1958
January 31,1954
4
10
1
10
31
"
Com
17.20
1. State minimum number of hours which employee was re
5
11
1
11
30
II
175.00me
175.00
quired to work per day, week, or month.
6
11
1
11
30
Il
com
23.98
HOURS
PER
7
12
1
12
31
u
175.00me
183.08
40
DAY
YEEK
MONTH
8
1
1-
31
"
1
175.00
37,13
31
"
2. How many days constituted a week's work?
9
1
1
1
)
com
57.04
5
10
3. How many hours constituted a day's work?
11
12
8
t
4. If this employee eorned any overtime during above period,
13
give the earned $ 5.00
exact amount
14
Rate for overtime 1.1.00 per hour.
15
16
5. If employee was furnished board, lodging, laundry, fuel,
17
or other advantages having a value which can be estimat-
18
ed in money (excluding, however, any sum paid to em-
ployee to cover any special expenses entailed on him by
19
8-20-15
28-55-40
acts of his employment), state estimated value per month
20
of each item furnished.
21
ITEM FURNISHED
ESTIMATED VALUE
22
$
23
ITEM FURNISHED
ESTIMATED VALUE
24
$
25
6. Has injured employee returned to work? Yes
No
26
If so, on what date? not returned
at whon
27
MO.
DAY
YR.
28
wage? $ 175.20
per month
29
30
Raza
camisasof sales
I CERTIFY THAT THIS
31
STATEMENT IS TRUE AND CORRECT
32
33
Date 2-6-59
34
35
Fort worth, Texas
36
City
State
37
38
39
Signature Sincley (4 Mylany
40
41
42
43
Sal:s yanager
44
RECEIVED
Official Capacity
45
46
47
FEB
0 1959
48
Kingis Candies, Inc.
Employer
49
TEXAS INDUSTRIAL
50
ACCIDENT BOARD
51
52
TOTAL DAYS WORKED
TOTAL AMOUNT EARNED
IAB 9.53
INSURANCE DIVISION - THE STECK co., AUSTIN

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    "ocrText": "EMPLOYER'S WAGE STATEMENT\nENG\nINDUSTRIAL ACCIDENT DOARD\nNOTE: PLEASE COMPLETE THIS STATEMENT IN DETAIL AND RETURN MITINAL TO THIS OFFICE\nAUSTIN, TEXAS\nPROMPTLY.\nSHOW NUMBER OF DAYS WORKED AND AMOUNT EARNED\nPERIOD COVERED\n5 $\nED\nWAGE RATE\nBY EACH PAYMENT\nOCCUPATION\n(BY NOUR\nAMOUNT\nSTATEMENT OF TOTAL EARNINGS OF\nFROM\nTO\n(TYPE or WORK)\nDAY. WEEK\nEARNED\nMONTH\n3\nOR MONTN)\nMarguerite C. Uswald\nMONTH\nDAY\nDAY\nSOCIAL SECURITY NO.\n1\n8\n28\n8\n31\nSales\n175.00 ma\n26125\n435-2:-5686\n2\n9\n1\n9\n30\nII\n\"\n\"\n180,00\n1\n\"\n\"\n\"\nFROM\nTO\n3\n10\n10\n31\n175.00\nAuguso F., 1958\nJanuary 31,1954\n4\n10\n1\n10\n31\n\"\nCom\n17.20\n1. State minimum number of hours which employee was re\n5\n11\n1\n11\n30\nII\n175.00me\n175.00\nquired to work per day, week, or month.\n6\n11\n1\n11\n30\nIl\ncom\n23.98\nHOURS\nPER\n7\n12\n1\n12\n31\nu\n175.00me\n183.08\n40\nDAY\nYEEK\nMONTH\n8\n1\n1-\n31\n\"\n1\n175.00\n37,13\n31\n\"\n2. How many days constituted a week's work?\n9\n1\n1\n1\n)\ncom\n57.04\n5\n10\n3. How many hours constituted a day's work?\n11\n12\n8\nt\n4. If this employee eorned any overtime during above period,\n13\ngive the earned $ 5.00\nexact amount\n14\nRate for overtime 1.1.00 per hour.\n15\n16\n5. If employee was furnished board, lodging, laundry, fuel,\n17\nor other advantages having a value which can be estimat-\n18\ned in money (excluding, however, any sum paid to em-\nployee to cover any special expenses entailed on him by\n19\n8-20-15\n28-55-40\nacts of his employment), state estimated value per month\n20\nof each item furnished.\n21\nITEM FURNISHED\nESTIMATED VALUE\n22\n$\n23\nITEM FURNISHED\nESTIMATED VALUE\n24\n$\n25\n6. Has injured employee returned to work? Yes\nNo\n26\nIf so, on what date? not returned\nat whon\n27\nMO.\nDAY\nYR.\n28\nwage? $ 175.20\nper month\n29\n30\nRaza\ncamisasof sales\nI CERTIFY THAT THIS\n31\nSTATEMENT IS TRUE AND CORRECT\n32\n33\nDate 2-6-59\n34\n35\nFort worth, Texas\n36\nCity\nState\n37\n38\n39\nSignature Sincley (4 Mylany\n40\n41\n42\n43\nSal:s yanager\n44\nRECEIVED\nOfficial Capacity\n45\n46\n47\nFEB\n0 1959\n48\nKingis Candies, Inc.\nEmployer\n49\nTEXAS INDUSTRIAL\n50\nACCIDENT BOARD\n51\n52\nTOTAL DAYS WORKED\nTOTAL AMOUNT EARNED\nIAB 9.53\nINSURANCE DIVISION - THE STECK co., AUSTIN"
}

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