FORMULARIO PARA LA

Formulario 110 V.4 PRESENTACION DE

FACTURAS

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

NUMERO DE ORDEN NIT PERIODO

MES AÑO
3481360 3868199019
06 2023
NOMBRES Y APELLIDOS: MAGALI CINTHIA CAMACHO ARTEAGA
A DOMICILIO: CALLE ANGEL ROCA 3015
TIPO DE DOCUMENTO DE IDENTIDAD: CI - CÉDULA DE IDENTIDAD NRO. DE DOCUMENTO: 3868199 LUGAR DE EXPEDICION: SANTA CRUZ

NIT DEL EMPLEADOR:

B NOMBRES Y APELLIDOS O RAZON SOCIAL DEL EMPLEADOR:
DOMICILIO DEL EMPLEADOR:

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
C85E41BE4A47ABFDE9315E6AE46C45D
1 183024024 6878 01/04/2023 58 E
182D9B7EC90DFC8523517FD74
6471324962AEF259361BF1449BC8909B
2 1467964011 288994 01/04/2023 112 E
CDEEADD9444F1C0FCA417FD74
4547BA1FB208B17ACB492CC22FA0D8C
3 1012531020 973 01/04/2023 214 E
D1698092E222DE79BAA417FD74
465AE83B4A00EC8684DBEE6F3CF9612
4 1028241027 128170 02/04/2023 379 E
C34680D664971C54827517FD74
1272DDE0424BBCAD7AE183A75C7BAD
5 269628024 37093 02/04/2023 127 E
575AF4F3ED3E860EFDB6817FD74
45CD068EB618190313A174133D75CBC
6 1020141023 29849 04/04/2023 5,983 E
5DD9FC775A49E52D8AFF17FD74
C3F202513AE10CAC54F8BB2526C6085
7 178984029 5123 07/04/2023 696 E
C8F70593E1811A1E21827FD74
465AE83B4A00EE445DCFF5D223B83BB
8 1028241027 142254 11/04/2023 156 E
F17D3FFE0C1206C899F637FD74
44E483E44EA337907AAA0AACD9FF7D2
9 1006867025 48656 11/04/2023 19 E
AECF42FAA0C1399586D937FD74
9ECA8E292413234715C4EAA0DA5A3CB
10 145046028 586 12/04/2023 243 E
464422AA478832D70FD37FD74
289D950E85535DEDF88474FF2EA74FE
11 593597011 132825 12/04/2023 42 E
A4657D6DDA77347E553A37FD74
139C7DBB8EC49D2A9B36DFA8E708AC1
12 4585910016 6823 13/04/2023 180 E
3BF4054F92631557A0FE147FD74
8388EE15F05CBEC8B075D8CA6F92BE1
13 120149029 552260 14/04/2023 105 E
37330DE2850FD4D284547FD74
44E5E1AA3639CD4A2F17DA11BACB838
14 1006945027 2401565825 15/04/2023 362 E
D268C4956A98C504E14988FD74
1B85D117EC69E4F70889A743E9C64C5
15 402245029 83842 15/04/2023 83 E
3D6B4F93D41588CB6DD547FD74
4661AB1B431C5EDC5237982183CFE7B
16 1028627025 73320 15/04/2023 44 E
B862772F1078AE69DBB847FD74
4511AC06943F89B71616AF31786AA9D4
17 1009445021 66390 16/04/2023 55 E
8871B099C7845FE788C47FD74
E8949E1158B4B06A93B89760002CA8B4
18 212448022 4418 16/04/2023 97 E
FAB61D5468A70B45DC47FD74
457AA11E6CC4C8A0ADDEE57DCB83F92
19 1015437029 4890 17/04/2023 999 E
53F64830C47367D4EE5057FD74
1272DDE0424BBFC257898A57FF569788
20 269628024 40448 18/04/2023 75 E
7D0DF3401F327E0660457FD74
465ABB618E612262E59D831CA4F9214
21 1028231025 4124 20/04/2023 120 E
B353E5E398163AC7A08857FD74

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 465ABB618E6122630F6859A74E11CFEF
22 1028231025 4007 20/04/2023 270 E
9D97ABB26863AC7A08857FD74
465CBA8FB1C1D1E18B5D045C188754D
23 1028345022 27033 22/04/2023 70 E
A89F6C515A17C1A8E05367FD74
9EF1CA4F32A613A017106B8B34B9C3E7
24 145186023 86408 23/04/2023 104 E
F3C48A504896B84FA667FD74
4661AB1B431C606B0AC8FBD230E4D73
25 1028627025 99005 23/04/2023 127 E
5B055672425015F99FA367FD74
9EF1CA4F32A613B8FD6C6E737D1704B
26 145186023 81819 23/04/2023 200 E
C46EFE62E6336B84FA667FD74

27 1735798013 113 1015545523731A 25/04/2023 90

AEEFD2D667EB62722951C7ED62C1DA2
28 159794022 103124 28/04/2023 70 E
C6D6CEBC8737C3D348977FD74
4661AB1B431C6161BF882AA63731BC8
29 1028627025 44104 28/04/2023 643 E
A94E9EADD0774CAB992977FD74
132073D80CB6021042E68AFFD1D4948
30 279538022 984 29/04/2023 584 E
3D42236F70845AD9B70A77FD74
1D26A20438572261561017145F57625E
31 426041022 6603 30/04/2023 114 E
B52607E0E3164BB55AD77FD74
4661AB1B431C61BFE37F638900B35035
32 1028627025 106575 30/04/2023 140 E
B98EF60B650DF74FC9087FD74
4661AB1B431C6FD36A091D808C33F47
33 1028627025 108863 03/05/2023 157 E
60C93E941636034E2F8098FD74
1272DDE0424BD020AAA9502F61DA325
34 269628024 43560 03/05/2023 106 E
CDDFA7FC922345E36CA098FD74
457ACDF26B0676597724690A366727F7
35 1015447026 16495 07/05/2023 66 E
8D222DDF689B1DD4BFF98FD74
465AE83B4A0100F294CB2A9D7F8771D
36 1028241027 179971 08/05/2023 117 E
7137ACF73E152E800450A8FD74
465A4FC1C266B3555DF842E4BC999412
37 1028207024 427766 10/05/2023 70 E
77EE031DC73F861D30BA8FD74
4661AB1B431C712C74E2E9B4C0D151B
38 1028627025 110240 10/05/2023 133 E
C8A8C3264095D4E939E6A8FD74
132073D80CB6123BB97B5470CB71E7C
39 279538022 588 13/05/2023 959 E
83BDFDAB786333BE54F2B8FD74
AEEFD2D667EC71BF40840674A8F0232
40 159794022 144679 16/05/2023 77 E
9AAE7EA26154246F8EDB8FD74
92795A23D9C951AFFA32E92FBD79642
41 133795023 148709 16/05/2023 450 E
C79C4C6D23401AE8E1EB8FD74
D8E3E4FEA2AAA7D07D909D647D1B276
42 3169854013 43 17/05/2023 2,500 E
243B9AE1CE789F0D9115C8FD74
468CB0322463BCD84774082770F63F30
43 1031083026 657 19/05/2023 749 E
CB28C700B10A4F5D18CC8FD74
4661AB1B431C73193A8967D5001EE4E
44 1028627025 80135 20/05/2023 477 E
78FE8ADCE6780A061DEFC8FD74
457AA11E6CC4DC76486744D793BBBA3
45 1015437029 6590 20/05/2023 999 E
F7092A50AC998E306310D8FD74
45CD068EB6182F5F5A1BE72D88DDD15
46 1020141023 32485 20/05/2023 2,783 E
411467DAD272C135CC10D8FD74
16B050042CBABBAB7C48748422178B4
47 331596028 19011 21/05/2023 179 E
C62DCECFBFF6CAD63CE3D8FD74
100EACA905DC2D446433F02755BCE16
48 234678025 5857 27/05/2023 630 E
7998F2192A13C98C6E6AE8FD74
16B050042CBABD089ACD973615D3B98
49 331596028 20939 28/05/2023 501 E
BC8206AE0FF1C4D42DEDE8FD74
AE3C759777A9335C33155F1284F77514
50 159154029 9795592701 28/05/2023 6,623 E
277D3AC2629E7831CA2AFD74
AE3C759777A9335C33155F1284F77514
51 159154029 9795592702 28/05/2023 6,623 E
277D532C129E7831CA2AFD74
4663866E7148128D8607AFA1362746D3
52 1028733026 382985 28/05/2023 73 E
D7D1813BA29B03014DAE8FD74
4556C1876449249BF6F56B3EE9FBC614
53 1013389020 1266 29/05/2023 376 E
6E3B38434606259D0C1F8FD74
4556C1876449249BF816647D4E940B47
54 1013389020 1267 29/05/2023 376 E
883439C9E106259D0C1F8FD74
1272DDE0424BE3007749D7D8A4B517D
55 269628024 49599 01/06/2023 152 E
1ECFC7E917F359AAD0CDF9FD74
16B050042CBACB1729F65D41879B0ED
56 331596028 12079 01/06/2023 627 E
8464B9B97AF6981E90EDF9FD74

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57 307444020 4 1013AB1E52841A 02/06/2023 3,480

4661AB1B431C82E383C5E9C2C2846560
58 1028627025 20069 02/06/2023 89 E
E0C1A85D26272B066610AFD74
45CFB91CE4BA5011FC1DA0DAE0EC5DF
59 1020295022 4676 02/06/2023 135 E
570C73B828B99F7011610AFD74
289D950E855382858E8148E2AF8BBDE
60 593597011 222036 02/06/2023 70 E
4DF9B940C8554385B11EF9FD74
100F18456037D1C1B3EB08F4CFA37B31
61 234702023 7720 02/06/2023 104 E
84AAA049A35DF11EC510AFD74
465D1D379A8F8D5FE83D885A1990894
62 1028367023 497919 03/06/2023 264 E
E88F386996315EF1C0750AFD74
45CD068EB6183FBC2A04B0CC598A3FB
63 1020141023 33472 05/06/2023 2,775 E
05D7A5FB8027442613CC0AFD74

64 9782016018 297 10175788F691A 07/06/2023 200

4661AB1B431C840BE8B80F8F748EC1A
65 1028627025 111284 08/06/2023 300 E
BA16A57688668C6170C71AFD74
9EF1CA4F32A84D9CCB6C18919B837E3
66 145186023 109716 08/06/2023 104 E
A42035D4865D4280DD71AFD74
4661AB1B431C840BF06E4EEA25FD63B
67 1028627025 90901 08/06/2023 76 E
CFEA8D96B2668C6170C71AFD74
1272DDE0424BE48B64D6DA8AC239DB
68 269628024 51296 09/06/2023 100 E
016600FFFC239808F3E8B1AFD74
4661AB1B431C8565DDD138C0CA25A3D
69 1028627025 98086 15/06/2023 186 E
1C56BACDBC1150D924D13AFD74
180DB9EB66E99AC250D188F46D7DD17
70 351544023 1419 17/06/2023 90 E
248D411B8E1646A405893AFD74
B5EB51F7AC1581824CDDC2B93E5EFD8
71 166172023 19 18/06/2023 90 E
9FA1D97DE568F5A6B5D3AFD74
4661AB1B431C85F5DDBAA89C324A6FF
72 1028627025 89990 18/06/2023 131 E
446AEDB57C74648A210D3AFD74
465ABB618E6148B0101C1ED5F09980EF
73 1028231025 6897 19/06/2023 100 E
6170E57CA02F7EBD5DD3AFD74
457AA11E6CC4EF87271B172E81108E23
74 1015437029 7740 19/06/2023 999 E
93FB7FCD849AC4231E04AFD74
465ABB618E6148B19DAB42821AFC532
75 1028231025 5134 19/06/2023 100 E
5D6FE635CC42F7EBD5DD3AFD74
455F4DD3F4338FEEF5746EFA9043D655
76 1013877027 2419 20/06/2023 605 E
48A8EF99E1989CF7FA44AFD74
14C0768A6A56F1DED004ED2E117FCF0
77 303288025 10444 21/06/2023 99 E
FB0E9DCC7879D48EAFF44AFD74
4661AB1B431C8689352B8CC05C1BAE7
78 1028627025 123935 21/06/2023 193 E
A01B5BF4D6153B113E284AFD74
466454ACF71322501A60633C4D1A9F47
79 1028779020 20982 23/06/2023 155 E
D1142C7DD07DFCD4EDF4AFD74
14C0768A6A56F27633FC4F954E8566B5
80 303288025 10855 24/06/2023 110 E
0B8C4FEA615B0E169D35AFD74
132073D80CB6279E799EFA3C1073DEF
81 279538022 1959 24/06/2023 183 E
D02FA06B26040F2F36705AFD74
4661AB1B431C871B4666BDF535533D1
82 1028627025 87249 24/06/2023 147 E
C3FD978E8A518BADA1535AFD74
132073D80CB627CDB789DA95B4B5039
83 279538022 1231 25/06/2023 183 E
EF44913DB698641DFF245AFD74
4661AB1B431C87B61CD1ACE38020439
84 1028627025 106415 27/06/2023 124 E
0AEFE01E7695ACC3BE7E5AFD74
1272DDE0424BE8344CABFF0C7C5DE88
85 269628024 65202 28/06/2023 422 E
DEF995EDB6735FED3A826AFD74

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 CANTIDAD TOTAL FACTURAS PRODUCCION NACIONAL 0

CANTIDAD TOTAL OTRAS FACTURAS 85

DETERMINACION DEL PAGO A CUENTA COD. Bolivianos

D DETERMINACION DEL PAGO A CUENTA
Monto otras facturas y facturas electrónicas
COD. Bolivianos
Cod. 26 49,977

Monto facturas producción nacional Cod. 113 0

DETERMINACION DEL PAGO A CUENTA OTROS PRODUCTOS Cod. 115 = Cod. 26 *13% 6,497

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 6,497

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
MAGALI CINTHIA CAMACHO ARTEAGA
DIA MES AÑO

16 07 2023 FIRMA CI 3868199 SANTA CRUZ

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