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
3781213 3868199019
09 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
1A5730576FC05EFF57E17C28A336473D
1 384968028 9069 03/06/2023 60 E
44FDEAB22441D35EDB50AFD74
1272DDE0424BE3955329F5268B87936B
2 269628024 50310 04/06/2023 27 E
B755BB77E1515A26DE80AFD74
CD3B2BF8E99640FD51FFC0246575B96
3 187466029 14572 04/06/2023 60 E
A885179B804EC6AB4F50AFD74
44E483E44EA35D5416F0765EE74C60F4
4 1006867025 45105 07/06/2023 25 E
5B01B544AB83ED1BEF31AFD74
AEEFD2D667ED8A49A4B8979A629ACD0
5 159794022 196905 07/06/2023 70 E
F01DC92FA850F5D77641AFD74
1272DDE0424BE581EE96CF0E91BDE10
6 269628024 52445 14/06/2023 56 E
B035C753846353B4CF2E2AFD74
AEEFD2D667EDA623A89A431E3598CAC
7 159794022 217569 16/06/2023 70 E
9D98F3F2A0037274EE53AFD74
A90E453DE74D08571FAC810C69FCD42
8 154422029 4550955893 18/06/2023 30 E
44786F67213B8FE64AF4AFD74
1272DDE0424BE64704A94BC671EF402
9 269628024 53265 18/06/2023 78 E
6790A5870BF99E15C51D3AFD74
1272DDE0424BE6AA2F241EE7F9879C4
10 269628024 53661 20/06/2023 48 E
2393EB4B04232EDB39844AFD74
465ABB618E614943F9A2B83333830908
11 1028231025 4537 22/06/2023 30 E
26C0D469A579141E2094AFD74
139C7DBB8EC49FB4F0ACD21428B0085
12 4585910016 8707 24/06/2023 78 E
C509408A53E10453D93245AFD74
8388EE15F05F45A2C0C4B88495106158
13 120149029 468823 24/06/2023 70 E
0A7EF20680CBCF8E405AFD74
EF39CB9184915B49F9540B0C6936B3F9
14 218518027 70605 25/06/2023 42 E
F22372E30873AC36175AFD74
1A5730576FC0643372B50C65AB502857
15 384968028 11052 30/06/2023 96 E
FAE1BC838009DFFCE4A6AFD74
AEEFD2D667EDD1274B9FA34CBBC7776
16 159794022 248695 30/06/2023 70 E
C2B27A7464102CAD81A6AFD74
463BDE4DE6B774D58239DF448AF49ED
17 1026469026 17221 01/07/2023 1,985 E
99D8FD1A929579CE4D227BFD74
CF61998F3BCF3F2B467797D7AC618821
18 189430022 23773 01/07/2023 102 E
EE54F382437952BE7A6AFD74
4661AB1B431C95F1A67507873530C507
19 1028627025 76844 01/07/2023 105 E
0D3510238753D0A9A227BFD74
463A779267B33F0C3647BC15E1D4D05
20 1026389026 3961 01/07/2023 50 E
7476E1881A125A8E6D6A6AFD74
465AE83B4A01261BD3023D6693D1984
21 1028241027 254184 01/07/2023 248 E
4C79B27810229320F98A6AFD74

Página 1 de 5
 C182B57F3C2E647ADA901A9D289D99F
22 176760020 55203 01/07/2023 466 E
6F983597F8876241C227BFD74
1272DDE0424BF674A307D793C250808
23 269628024 68191 02/07/2023 52 E
A1A51B3B57024E486D467BFD74
100F18456037E533E9B170AA60B7C478
24 234702023 5460 03/07/2023 90 E
848C27CCD00225AFD997BFD74
ABEF59D79428A3B43C98B2A94713A6C
25 157052020 1896 03/07/2023 440 E
167F86910815D6B72C67BFD74
C182B57F3C2E6AD4014A9EB1138A4BD
26 176760020 74816 03/07/2023 54 E
35E0DCA824657DBFD997BFD74
14142C6303CB55B5D737037FEB7DE4F
27 293452024 646 03/07/2023 66 E
7E4FB8637C1231AC70867BFD74
18FF77C30654EB83A2EFDCA91E83D82
28 365345027 12193 03/07/2023 50 E
BEA5F598AA56BC29A80A7BFD74
159F68DF0087ACADAF9EC8AA07277E6
29 316016026 17136 04/07/2023 618 E
4C3EBA7F61B115E088AD7BFD74
465AE83B4A0126B2468C36A4E24C91E6
30 1028241027 258860 04/07/2023 135 E
D22B0683849AC992C7A7BFD74
4661AB1B431C968A0AABB6BA3C3F768
31 1028627025 77617 04/07/2023 55 E
A8E89ABA4A7097FF975D7BFD74
9EF1CA4F32A978A9C01EBD0F51AA3D1
32 145186023 122152 05/07/2023 140 E
E9A655A901308B077318BFD74

33 7677305019 273 101CE49D92D21A 05/07/2023 200

457ACDF26B069CDB3B8071928F3102C
34 1015447026 39319 07/07/2023 160 E
BF6F24C886699661F0D88BFD74
465CBA8FB1C208C6CFB2E5DA8CB58D4
35 1028345022 10462 07/07/2023 70 E
BBBD97FBEC429143CAD88BFD74
1A5730576FC07338B6EDC8C924AEDCF
36 384968028 11678 08/07/2023 60 E
8075577B6C17787442DC8BFD74
1272DDE0424BF7C9F2A773409294A73
37 269628024 57332 09/07/2023 108 E
D8A1996309F8835DD1609BFD74
457ACDF26B069D42A3801264886CBDC
38 1015447026 20957 09/07/2023 69 E
C14112658234540BB6B09BFD74
4661AB1B431C977E8ECF0F78086C9010
39 1028627025 119714 09/07/2023 77 E
EEEC9691466EB6FF7FF8BFD74
457ACDF26B069DA5372DEF4715A7431
40 1015447026 40555 11/07/2023 87 E
FCCF64684E1123B31A289BFD74
1272DDE0424BF8C3F43706221805972
41 269628024 58487 14/07/2023 80 E
DFE2F7894844708326B2ABFD74

42 229626022 122 101D151835011A 15/07/2023 280

465CA8A7F485B2EEE957241D7303E3D
43 1028341029 12753 15/07/2023 190 E
A1EA83D08A07D2A19673ABFD74
950D15802D17E0AC1DF93EE052872A8
44 136149025 27030 16/07/2023 150 E
3266F901C1609FECA9AABFD74
4661AB1B431C99096C50EDB69027D46
45 1028627025 6354 17/07/2023 318 E
8F9D458EF448D90365CDABFD74
45CD068EB618558169108D0E6E019DA
46 1020141023 37651 18/07/2023 2,350 E
CE6E9485DE1530D848B1BBFD74
AEEFD2D667EEE34FB3E25B438F6C096
47 159794022 291835 19/07/2023 70 E
AD439CDEE74D65D17A5BBFD74
457AA11E6CC502C56142378009D931EF
48 1015437029 8920 19/07/2023 999 E
383C88570489FFB7675BBFD74
45CD068EB61855E469CDCD38DC685F3
49 1020141023 38044 20/07/2023 2,350 E
2A96CA009814E522AB29BBFD74
1A67ABEE75C8619DC23902512A7AC27
50 385909028 4528 21/07/2023 193 E
93114B9AE0935026584DBBFD74
46561B906B39DE3F9C1261B607C30407
51 1027967025 906202 22/07/2023 219 E
31B23F04464D704B760CBFD74
46561B906B39DE3FA6D14BFCD4E2961
52 1027967025 906204 22/07/2023 369 E
A52B94211884D704B760CBFD74
457ACDF26B069FEF85D236734570759
53 1015447026 43415 23/07/2023 32 E
C3698B6886590F474BE0CBFD74

54 1735798013 1660 101976228EA61A 24/07/2023 268

4661AB1B431C9A5F822D0CAE8270A2C
55 1028627025 79782 24/07/2023 135 E
52316932BC672B9C19D7CBFD74
AEEFD2D667EEF5BD5B867D171CB6F73
56 159794022 306040 25/07/2023 70 E
06E847FB03764E2F2CBCBFD74

Página 2 de 5
 14C0768A6A5705E5EEEDF321B46A709
57 303288025 15183 25/07/2023 198 E
6F77E1BEB621E48DD9DBCBFD74
157BEBFB5B95F29DD8645F450110D25
58 313990028 9716 27/07/2023 165 E
C08C095F0BB8EB96FA13DBFD74
4661AB1B431C9B59886E6AA35B528956
59 1028627025 132511 29/07/2023 290 E
5288413D674BC3B797ADBFD74
465AE83B4A012BB0543BFD9E01B6969
60 1028241027 291968 30/07/2023 53 E
4E6705D500127450B75BDBFD74
AEEFD2D667EF085B38A2F86D155331A
61 159794022 321527 31/07/2023 70 E
D7549744653B09FCD72EBFD74
465AE83B4A01398D3776CF13F8816DB
62 1028241027 295682 02/08/2023 67 E
A2214806D4072F3D3097ECFD74
8388EE15F0617080EBE371EF8BCCD0C
63 120149029 36911 04/08/2023 100 E
0F4A25B7609771F0E22FCFD74
16EAF8C4C8B31320DE8335EC6800B8A
64 5359118014 217 06/08/2023 270 E
BF2FCCE79DA578F0E79D9FCFD74
C85E41BE4A4C8F0A54F217063A754047
65 183024024 17616 07/08/2023 71 E
6AD9C62070E826705DFCFD74
1491730F3930F595D8D30969D5A47FA
66 300604023 529 08/08/2023 1,810 E
64BDFABB0A51F80B48210DFD74
4661AB1B431CAAF3CA985EFD74D05ED
67 1028627025 169269 10/08/2023 204 E
80C9CA57F261670A19380DFD74
45CD068EB6186739E24C0A6BB505368
68 1020141023 40293 10/08/2023 4,343 E
C53DE07BD211E99252780DFD74
AEEFD2D667EFFEC1E0BF0C427747C75
69 159794022 347390 11/08/2023 84 E
1BD6BF12C254421432C0DFD74
457ACDF26B06B113A90B6228FB2E387
70 1015447026 46168 12/08/2023 137 E
4437E7F47098E95B487C0DFD74
4661AB1B431CABB8EA13EA46ADAE8B0
71 1028627025 120772 14/08/2023 36 E
70FE394F2834F32CCF171DFD74
457ACDF26B06B17B323DE93F39CA6E2
72 1015447026 59831 14/08/2023 21 E
6B4769F5C6528094CC671DFD74
457ACDF26B06B17B24C9C1D9FDA7B10
73 1015447026 59827 14/08/2023 104 E
0EA7C9941E628094CC671DFD74
46176F4671E8FEA29A2DBDB2F4E6AEC
74 1024389029 28800 15/08/2023 329 E
12410D5D0055D3B10EF71DFD74
180B84E70D3DCF39C3FFCC49A89F32F
75 351418020 404168 18/08/2023 253 E
ADC5300ED078A0390B232DFD74
AEEFD2D667F01462233E46E01CE04371
76 159794022 365789 18/08/2023 70 E
5BC69B82563001F1F22DFD74

77 174762025 429 101EB5A221F81A 19/08/2023 128

1A5730576FC08898F5E4FA5EF00C2975
78 384968028 17077 19/08/2023 151 E
ADA5A5EF27676C51F6A2DFD74
457AA11E6CC5160CDC171E8E8178392
79 1015437029 10545 19/08/2023 999 E
C66D637E4A752B1ADFE92DFD74
45A2522DAB85A1749BC439B4D8ED517
80 1017703021 18235 20/08/2023 456 E
D916C0CE6F32FC177D7D2DFD74
E9110DB881B7A7CFA43903025B01AD8
81 212892025 9749 20/08/2023 235 E
6BC9854B2358FC16E9A2DFD74
1272DDE0424C0D5FAE86064B533E2B5
82 269628024 28424 21/08/2023 108 E
5E00CB8152502CB4C1513DFD74
465CBA8FB1C21F1DF1530441247BB6A
83 1028345022 32476 23/08/2023 70 E
9AC188A718164915C1093DFD74
4576F367EA7D4A9F4F0020A252BD76F0
84 1015227020 21890 23/08/2023 900 E
8ADE15FD492E0C86BC53DFD74
4661AB1B431CAD74198E1FDAFD0764E
85 1028627025 127511 23/08/2023 66 E
FC52A73D86527C0ED6A83DFD74
465ABB618E616FFB820B251C6B84DDA
86 1028231025 8565 23/08/2023 190 E
484FAD6A720104276BC53DFD74
44E7A20FFD80D1B23090046141517C7F
87 1007045023 6809 25/08/2023 108 E
C0865235A14B0DBAE3D3DFD74
AEEFD2D667F02CD3B4AF74060D0ED3E
88 159794022 385997 26/08/2023 21 E
B8C4DCAE223A62556F04DFD74
1A825DC65DB2FC98D4C52CC71BA17F8
89 387433026 9375 27/08/2023 399 E
B179B8D9D6F714B3C1974DFD74
46176F4671E900EE239B7C623CB8CB70
90 1024389029 60044 27/08/2023 600 E
CEE8A05F88850D812B44DFD74
136A94C780228BA2A891C8C9DEF7EA6
91 283770020 381 27/08/2023 84 E
30AE8E1DC2164289B9F74DFD74

Página 3 de 5
 E8949E1158B9A2EC94395792D7836FC2
92 212448022 1153 27/08/2023 98 E
96AFBD6A459AAF73384DFD74
950D15802D193CF1117C02553B98732
93 136149025 30529 29/08/2023 190 E
B1A2F40EA87602823AF4DFD74
BDCF6EF6C4E3A1C9B37955ECA1F0DDF
94 173380028 69483 30/08/2023 570 E
DDA9C324E360024DCB25DFD74
AEEFD2D667F1144F67D4784CE4A2BFD
95 159794022 400905 01/09/2023 70 E
C76DB87BA173B4F0ECB5EFD74
180B84E70D3DDF98DD54BC696A9E04E
96 351418020 432063 03/09/2023 288 E
EB688A951669FC6EA71C5EFD74
ACA6A453F1D433E026110647A39BA87
97 157706024 14053 04/09/2023 420 E
A7E88FAD347C6542BC66EFD74
139C7DBB8EC4A313A4B2BF5AEF03FBA
98 4585910016 10466 04/09/2023 210 E
FF82E906594383D1EA3D66EFD74
457ACDF26B06C3012DB41A8BFFD025D
99 1015447026 55776 05/09/2023 142 E
F67D3FFEC0993DBEA5AA6EFD74
AEEFD2D667F126CC6ACCE9E13E2E271
100 159794022 415706 07/09/2023 35 E
9F0DF104413B1E1BD127EFD74
AEEFD2D667F12FE2736CA6E1C8E71BD
101 159794022 422549 10/09/2023 105 E
6E26BA9B2957AAF29D97EFD74
465A4FC1C2670181BA9E1A9395345BC
102 1028207024 225370 16/09/2023 98 E
D07CD9354428C59BAE309EFD74
196756CE534CCC3B98E68AFF67EA1714
103 371275028 3999 22/09/2023 272 E
D4FB727D647303526F9AEFD74
92795A23D9CE3AF13275CC267CB9ACC
104 133795023 32033 24/09/2023 150 E
481D3AFAA058AFBB90EAEFD74
465ABB618E61836EA921F9355CC163BA
105 1028231025 10284 24/09/2023 100 E
0B3115A3821D9B28C0EAEFD74
180B84E70D3DE3D13ED965617C85DD3
106 351418020 471996 25/09/2023 542 E
75DBF4A3D854FF2136C1BEFD74
AEEFD2D667F16730855B9B26F5BA856
107 159794022 465868 28/09/2023 70 E
4458EE278135AAA5EACBEFD74
457AA11E6CC52B375CB210075FFDFBD
108 1015437029 12291 29/09/2023 999 E
0C686A013E02064218B3CEFD74

109 6226222015 246 101D3B89E9831A 29/09/2023 1,420

110 6226222015 237 101D3B89E9831A 29/09/2023 2,360

C182B57F3C31266634FDC653F8BCB95
111 176760020 93012 30/09/2023 92 E
EEDD518C9F900EF8347CEFD74

CANTIDAD TOTAL FACTURAS PRODUCCION NACIONAL 0

CANTIDAD TOTAL OTRAS FACTURAS 111

DETERMINACION DEL PAGO A CUENTA COD. Bolivianos

D DETERMINACION DEL PAGO A CUENTA
Monto otras facturas y facturas electrónicas
COD. Bolivianos
Cod. 26 35,886

Monto facturas producción nacional Cod. 113 0

DETERMINACION DEL PAGO A CUENTA OTROS PRODUCTOS Cod. 115 = Cod. 26 *13% 4,665

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 4,665

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

Página 4 de 5
 JURO LA EXACTITUD DEL PRESENTE FIRMA Y SELLO EMPLEADOR
LUGAR ACLARACION DE FIRMA
FORMULARIO
SANTA CRUZ
MAGALI CINTHIA CAMACHO ARTEAGA
DIA MES AÑO

09 10 2023 FIRMA CI 3868199 SANTA CRUZ