FORMULARIO PARA LA

Formulario 110 V.4 PRESENTACION DE

FACTURAS

FORMULARIO ANEXO
X Funcionario Dependiente Anexo al Form 702 (STI)
Anexo al Form 610 (RC-IVA) Anexo al Form 510 (Profesiones
Liberales u oficios)

NUMERO DE ORDEN NIT PERIODO

MES AÑO
3454313 0
07 2023
NOMBRES Y APELLIDOS: MOISES CRISTOBAL MONTAÑO ARANA
A DOMICILIO: AV. BOLIVIA B/24 DE JULIO
TIPO DE DOCUMENTO DE IDENTIDAD: CI - CÉDULA DE IDENTIDAD NRO. DE DOCUMENTO: 5388730 LUGAR DE EXPEDICION: SANTA CRUZ

NIT DEL EMPLEADOR: 1011931025

B NOMBRES Y APELLIDOS O RAZON SOCIAL DEL EMPLEADOR: BOLIVIA PETROLEO Y GAS CONSULTORES Y SERVICIOS S.R.L.
DOMICILIO DEL EMPLEADOR: CALLE YAPICUANA NRO. 201 ZONA/BARRIO: VILLA MERCEDES

C DETALLE DE FACTURAS CON DERECHO A CREDITO FISCAL (En Bolivianos)

NUMERO DE FECHA IMPORTE DE LA CODIGO DE
Nro. NIT NUMERO DE AUTORIZACION / CUF TIPO FACTURA
FACTURA DIA/MES/AÑO COMPRA CONTROL
CFFAF2D000FB398A1B2A23A3A5374B9
1 3039635015 440 17/03/2023 112 E
BC6682763013C80364CBD5FD74
6C063D72C6B039B58C939FB117981F54
2 1578778011 89851 17/03/2023 63 E
0951B1BEE8940A5985CD5FD74
CFFAF2D000FB39BB6A3F07D7FB9F3EE
3 3039635015 496 18/03/2023 56 E
D5BEA18D60969223F97FD5FD74
8388EE15F05B96A6B20475CA52F6F153
4 120149029 315088 18/03/2023 28 E
38B762205735F6090CD5FD74
4663F20D1762C79ADFD2B318D79A470
5 1028757026 117 21/03/2023 116 E
80B544F07A07655C7E8AE5FD74
CFFAF2D000FB3A4A5B55114F9F11499A
6 3039635015 41 21/03/2023 56 E
6F62628FA04AB4BF6AAE5FD74
465A4FC1C2668F4D47CFF52FDFE57430
7 1028207024 619987 23/03/2023 35 E
1D77AD15E183B64B1AEE5FD74
465DACBB8ABC04C68914F39A5F82E0D
8 1028399028 2262965 24/03/2023 10 E
330733D0F2320ED37C06F5FD74
CFFAF2D000FB3AE38503F04EC88D7B6
9 3039635015 413 24/03/2023 56 E
DC98C9A302518F7304D5F5FD74
CFFAF2D000FB3B150A39D309F5B1755
10 3039635015 583 25/03/2023 56 E
0134A9D9660626D0BD89F5FD74
465A4FC1C2668FB5BEB38D58058A297
11 1028207024 627802 25/03/2023 35 E
A104D41D4441F18EBEC9F5FD74
45D6DEA712626A40D533FED2D21CE22
12 1020703023 721239 26/03/2023 20 E
E7F1BD060997A2A3F76DF5FD74
457D0BEC5C1FE6C5C41BB54780C0DAD
13 1015575027 106350 27/03/2023 28 E
485450938C591FEED93106FD74
465A4FC1C2669046C4E20CE1F588D04
14 1028207024 635108 28/03/2023 35 E
BBB28CDE6836E282DBF406FD74
45D6DEA712626AD89ECCA1553642487
15 1020703023 786355 29/03/2023 20 E
C354CEF82152499AF49806FD74
457D0BEC5C1FE728660FD77884857687
16 1015575027 108374 29/03/2023 35 E
4AD81999C328FE45E8806FD74
457D0BEC5C1FE75DFF2AE59241E3809
17 1015575027 109898 30/03/2023 35 E
FE6C82F0A451E3ECB2BC06FD74
6471324962AEE4DBB659D5429114A4D
18 1467964011 286565 31/03/2023 21 E
35DF4337D2613B6CB7EF06FD74
45CF44840FB31044D2A8BE25A0199D9
19 1020269020 1623382 31/03/2023 32 E
2BC4647D9C45E30E55FF06FD74
45D6DEA712626B3DAFBEEFF6A601615
20 1020703023 839280 31/03/2023 20 E
85F8364A63B142D7402016FD74
45CF05BCD978C78BD13F255F4DFF4DD
21 1020255020 43311306 01/04/2023 169 E
67C52C93A480F9B1399016FD74

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 6C063D72C6B049DC3397880DE77D53C
22 1578778011 101857 01/04/2023 14 E
2C8E74172A32BB9E23D417FD74
45D6DEA7126278E7EF24EC6BB32B467
23 1020703023 873547 02/04/2023 20 E
AC082A3F1167FA04378817FD74
6471324962AEF28B863A4783C9EC2CA5
24 1467964011 290352 02/04/2023 35 E
BBD0C5FE0843FED966817FD74
6C063D72C6B04A1381927F68A0903536
25 1578778011 103019 02/04/2023 70 E
6BFD2E84E02B30FE60917FD74
97FB7D6D217F1FF08AFE44AAE97FA1D
26 2221225010 99695 03/04/2023 21 E
A59F35E7F6677F01947C17FD74
465A4FC1C2669EBBF12D8AE9363E9FA
27 1028207024 370809 03/04/2023 35 E
969B685A1A142401B76C17FD74
CFFAF2D000FB4A192D77B371B87B0E9
28 3039635015 307 03/04/2023 63 E
60844F871E18C1AA502C17FD74
453D5290062DAA861541115AA457586
29 1011937026 71195 04/04/2023 21 E
416E4E2F2E47F8CC953027FD74
45D6DEA71262797C649B38096A3B7BE
30 1020703023 938962 05/04/2023 30 E
DAF378B4F7923F9B34B327FD74
CFFAF2D000FB4A7C394E480DEF87A5C
31 3039635015 387 05/04/2023 112 E
CDFDB7283E13CD06B39327FD74
CFFAF2D000FB4ADAD18000575C7DE5F
32 3039635015 62 07/04/2023 56 E
3A4D4829AC584E01170B27FD74
CFFAF2D000FB4ADF4BAE6C3ED7A7461
33 3039635015 446 07/04/2023 56 E
11E67CC8AC484E01170B27FD74
6C063D72C6B04B3B5F47F3656FBAA39
34 1578778011 108961 08/04/2023 42 E
15C5E994AA719898ABAE27FD74
CFFAF2D000FB4B723FB5FCDA0F0EF0F
35 3039635015 390 10/04/2023 56 E
ADEFE7717C333CE9143637FD74
465A4FC1C266A013F502E1645D479B9
36 1028207024 381430 10/04/2023 28 E
DE40237FDC64DF57BB7637FD74
45D6DEA712627B04404003640D4A998
37 1020703023 1082072 13/04/2023 20 E
BA8088BD7351DA80A18147FD74
465A4FC1C266A0D3BF013180054324BE
38 1028207024 386721 14/04/2023 21 E
A6135D6AA78FE20C8A147FD74
465A4FC1C266A0D2F0ED334D4230D4C
39 1028207024 386600 14/04/2023 21 E
6C5DDA4C9088FE20C8A147FD74
465CBA8FB1C1D0877B6D01A21BD3ED9
40 1028345022 27839 15/04/2023 21 E
E9EDBC2F16788CDDF24947FD74
4663F20D1762DA17FC46E255518F11A5
41 1028757026 1715 17/04/2023 116 E
D995D5625D370543F2057FD74
CFFAF2D000FB4D62AF76702F0B5F931E
42 3039635015 718 20/04/2023 63 E
EB5A6B94C662F2ED87B57FD74
45CF44840FB32168DC96935DCED4D63
43 1020269020 1639575 20/04/2023 9 E
936A6CC68697ECBF528B57FD74
45D6DEA712627C5DD708AB9B6EF96EF
44 1020703023 1216352 20/04/2023 20 E
8164EEADC3700166559B57FD74
446D55AD9E855CF2C3161BCBF0FD7BB
45 1000063020 38399 22/04/2023 129 E
FAB4F8CB96876A23561367FD74
465DACBB8ABC17A841899A2FE14DFAA
46 1028399028 2990772 22/04/2023 10 E
266574E688420B59802367FD74
45CF44840FB322688769DDE73DF51BE
47 1020269020 62136 25/04/2023 35 E
F51301003003CA39351E67FD74
4661AB1B431C60C76823C56711191326
48 1028627025 61711 25/04/2023 109 E
95C3BD03628C8D49CFD67FD74
201F734F81D383AF38B635D7C401A855
49 469476026 2661 28/04/2023 325 E
CC7160DD22606E35EF977FD74
463069AE29FA2611C8EEE73CF9F0B9D7
50 1025815029 29198 28/04/2023 270 E
AF3BA51CC1464C2395977FD74
463069AE29FA261142CAB9F084207A14
51 1025815029 11291 28/04/2023 60 E
9DD6E932E736C103B4677FD74
A7E1454E3A3A2B63C589EE2DC95A4D7
52 153348026 86436 28/04/2023 67 E
6CE856DE884ABB510B977FD74
457ACDF26B0667877922A6FB1EBBE2E
53 1015447026 37447 30/04/2023 104 E
F48714016636B842CE6187FD74
45D6DEA712627E4A7D274010E5039DD
54 1020703023 1404023 30/04/2023 20 E
2641D861499324D416D087FD74
CFFAF2D000FB5CFA66AD2B0A4946AB7
55 3039635015 516 01/05/2023 105 E
5DC5D375A8374300983988FD74
45CF05BCD978DACE329C44E91C2ADC7
56 1020255020 48362539 01/05/2023 169 E
1CD007B1CE33300EA66187FD74

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 A90E453DE74BA90CFB041053759B195F
57 154422029 1364044049 04/05/2023 4,664 E
7659890A307AFDDB9DB8FD74
180B84E70D3D92BEDDA54BE139E24EF
58 351418020 216143 04/05/2023 75 E
835B0498B6156B5D4D6198FD74
19692D9EACA3D11895E239A88597C9C
59 371380023 531074 04/05/2023 70 E
79E38969D499014FC84198FD74
CFFAF2D000FB5D8D63D4C59636AA25B
60 3039635015 410 04/05/2023 63 E
AD9AC959C42407B8956498FD74
457ACDF26B0675C4FC3AF630CDEDFF3
61 1015447026 48921 04/05/2023 20 E
BD5D4C405A5952054EC498FD74
457ACDF26B06762B05059C956BACC72
62 1015447026 40554 06/05/2023 106 E
98F6728FE47456E1A14C98FD74
45D6DEA712628CEBE6A7103CDF4CC5A
63 1020703023 1525132 06/05/2023 20 E
C9A5E63BFB323B9555FB98FD74
CFFAF2D000FB5DF18CDE838350A11BD
64 3039635015 572 06/05/2023 98 E
FAAD78CCD8418AA3F8DB98FD74
1CFE735D5E24DE0949B950527422583
65 423747022 58 07/05/2023 91 E
D2BCFDD004434D7788EF98FD74
1A4501C54837EB6A717685955209FD88
66 383930024 1946 08/05/2023 55 E
EF9865DC47349DCA863A8FD74
CFFAF2D000FB5E520B2A39A7D2CECB1
67 3039635015 375 08/05/2023 56 E
535D46034637E1FE4C43A8FD74
45D6DEA712628D827C59063BD7841B4
68 1020703023 1589479 09/05/2023 30 E
9E746ED7A992D5F95227A8FD74
1272DDE0424BD144B0144647A8F1F5C
69 269628024 35702 09/05/2023 35 E
3A024D96DD20BF47C507A8FD74
4BF826134BCFE200458993860CD85082
70 1110293016 8681 09/05/2023 56 E
17FEE227A384F028A37A8FD74
1272DDE0424BD179559B9E3991F0DB2
71 269628024 35982 10/05/2023 25 E
8FD86E8ACCC4F04E6FBAA8FD74
457ACDF26B0676EAD512FB62419D3B7
72 1015447026 21213 10/05/2023 33 E
13BD650F825769991FEAA8FD74
691690E6B17AD08A052BEDDA70FA886
73 1535865011 85391 11/05/2023 21 E
C17A01C53631421B197EA8FD74
457ACDF26B06774EFD0FAE1EA32F933
74 1015447026 10913 12/05/2023 43 E
EE318186AA01A6AAAB92B8FD74
6471324962AF07B71659A7C6FE158197
75 1467964011 360856 12/05/2023 14 E
33E5028F0408713F232B8FD74
468CCB1AF3CA16615B5C99900C7250A
76 1031089027 92544 13/05/2023 49 E
A376ABEF0018887B4E46B8FD74
4661AB1B431C71EED8D851150493AAE
77 1028627025 66595 14/05/2023 49 E
AD210D967E6402289989B8FD74
457ACDF26B0677E2D4CBF2E467EDD50
78 1015447026 25333 15/05/2023 7 E
D47B61B972177DC1B8CDB8FD74
457ACDF26B0677E3E26A1D9EC24598A
79 1015447026 40039 15/05/2023 22 E
AF451832A664C1C1B8CDB8FD74
45D6DEA712628EA8319AE909B1706A8
80 1020703023 1699882 15/05/2023 20 E
2A4A6FB167A1F6E56C7DB8FD74
457ACDF26B0677E2D0554AE04F29968
81 1015447026 11326 15/05/2023 98 E
9AFBC8E9AC646803B8CDB8FD74
97FB7D6D217F35B371B6E7A7C7257F1
82 2221225010 138898 16/05/2023 14 E
C1BD50987440A60398EDB8FD74
4661AB1B431C7253419B30F392A93E16
83 1028627025 73703 16/05/2023 39 E
8D83375A685CC826601C8FD74
45CF44840FB333E606F04875041D585C
84 1020269020 1859773 16/05/2023 9 E
FBC747E423677EC1321C8FD74
4661AB1B431C72534010FCEAAE7FE0F9
85 1028627025 73702 16/05/2023 167 E
86F335D3C05CC826601C8FD74
6471324962AF08AD8F3B78F2E247F9B3
86 1467964011 370019 17/05/2023 14 E
4C68A02FE22B64553D4C8FD74
8388EE15F05DFF3811F2B24B7C3FD3B6
87 120149029 407897 18/05/2023 63 E
93CA56DA21F1BFF2D8C8FD74
457ACDF26B0678771632D53AC79D112
88 1015447026 26179 18/05/2023 21 E
68AD0267BE85BB16B5F8C8FD74
45D6DEA712628F3BB6074A2C84A2B4E
89 1020703023 1762676 18/05/2023 15 E
2216C4320B90B5FB69A8C8FD74
6471324962AF08DF067327D1EA6C25D
90 1467964011 372080 18/05/2023 14 E
5C2D3E90604904720D88C8FD74
457ACDF26B0678D7DABF518DA2405D3
91 1015447026 42053 20/05/2023 98 E
DFE8484492046F19DF20D8FD74

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 465DACBB8ABC2A855BB8B14D84663DF
92 1028399028 3664371 20/05/2023 10 E
BD79844E9E425FAE9430D8FD74
180B84E70D3D9605F96174624A166D5
93 351418020 246714 21/05/2023 166 E
3BE9081304937095C1C0D8FD74
457ACDF26B067939E79751A6DD0B925
94 1015447026 23272 22/05/2023 47 E
8C08CE2C1033407133A7D8FD74
4663F20D1762EE5549A23ED67F3EA979
95 1028757026 4530 22/05/2023 107 E
196E9CBBB94DA7FF657D8FD74
45D6DEA71262900336F9C45905B3DE8
96 1020703023 1843445 22/05/2023 30 E
5A73CAED75B67A3E1097D8FD74
457ACDF26B06793E681B1EFD5D377F1
97 1015447026 22324 22/05/2023 58 E
D8F059C388193513A518D8FD74
1AA143D43448D45560BE21AE4BCCE59
98 389197027 1141 23/05/2023 58 E
331226987224DBD08408D8FD74
4661AB1B431C73DDB25A07DC0289CE1
99 1028627025 74814 24/05/2023 230 E
EEC99D69AC272B1FE8DED8FD74
457ACDF26B06799B9228598320225894
100 1015447026 43685 24/05/2023 69 E
4C7A3E85299DF305FCBD8FD74

CANTIDAD TOTAL FACTURAS PRODUCCION NACIONAL 0

CANTIDAD TOTAL OTRAS FACTURAS 100

DETERMINACION DEL PAGO A CUENTA COD. Bolivianos

D DETERMINACION DEL PAGO A CUENTA
Monto otras facturas y facturas electrónicas
COD. Bolivianos
Cod. 26 10,439

Monto facturas producción nacional Cod. 113 0

DETERMINACION DEL PAGO A CUENTA OTROS PRODUCTOS Cod. 115 = Cod. 26 *13% 1,357

DETERMINACION DEL PAGO A CUENTA PRODUCTOS NACIONALES Cod. 116 = Cod. 113*15,6% 0

TOTAL DETERMINACION DEL PAGO A CUENTA Cod 693 = Cod. 115+Cod. 116 1,357

E DETALLE DE FACTURAS SIETE RG

NUMERO DE FECHA IMPORTE DE LA CODIGO DE
Nro. NIT NUMERO DE AUTORIZACION / CUF TIPO FACTURA
FACTURA DIA/MES/AÑO COMPRA CONTROL

CANTIDAD TOTAL FACTURAS SIETE RG 0

F DECLARACION DE MONTO PAGO A CUENTA COD. Bolivianos

Monto Facturas SIETE RG Cod. 464 0

PAGO A CUENTA POR FACTURAS SIETE RG Cod. 465 = Cod.464*5% 0

JURO LA EXACTITUD DEL PRESENTE FIRMA Y SELLO EMPLEADOR

LUGAR ACLARACION DE FIRMA
FORMULARIO
SANTA CRUZ
MOISES CRISTOBAL MONTAÑO ARANA
DIA MES AÑO

13 07 2023 FIRMA CI 5388730 SANTA CRUZ

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