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
4488737 4190893011
03 2024
NOMBRES Y APELLIDOS: EDWIN ALBERTO MELGAR SCHLINK
A DOMICILIO: URBANIZACION COTOCA
TIPO DE DOCUMENTO DE IDENTIDAD: CI - CÉDULA DE IDENTIDAD NRO. DE DOCUMENTO: 4190893-BE LUGAR DE EXPEDICION: BENI

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
465C2B186238731D3580B6659DFAA55
1 1028313028 262359 03/01/2024 49 E
4DC32EC106353D4F3573448E74
801A69BFBF75E72E3CAF271F6F439318
2 1872230016 109436 04/01/2024 35 E
167D6E15868BD1ADA27448E74
465A4FC1C26DEB42FD04E98704A3CB0
3 1028207024 325479 05/01/2024 18 E
EB7CB558A6547D441DFA448E74
465C2B186238737FCEF9CEA048A97D4
4 1028313028 265153 05/01/2024 35 E
0DD2A935EA47AC1A98EA448E74
465C2B18623873B11FF7028028F746FD
5 1028313028 266282 06/01/2024 28 E
1ACF4E16449C92842AE448E74
92795A23DA3CC1603569BA963FE2C9F
6 133795023 162320 06/01/2024 25 E
4F260D2A022C51BF06F448E74
465AE83B4A0839A26F121D7E1F27E0F4
7 1028241027 7480 07/01/2024 99 E
6717BF13057D8D0C36F448E74
801A69BFBF75E7EF52398B562C135A7C
8 1872230016 112420 08/01/2024 35 E
244A374E8112E1A9116548E74
6471324962B63FD700DF6C246D88737
9 1467964011 222044 08/01/2024 14 E
32054A041861AB038516548E74
6C063D72C6B7978D26F43775C9E32F6
10 1578778011 332569 09/01/2024 49 E
F5E826805A3710F307E9548E74
465C2B18623874738ABC1F8CB68F5097
11 1028313028 271584 10/01/2024 53 E
D7AAE84C075E036E88D548E74
8388EE15F0D177A8BD816BC4A2051BD
12 120149029 477207 11/01/2024 42 E
C800B4186716D7732ED548E74
19692D9EACAB0B831305F5AB93CE3AE
13 371380023 306955 12/01/2024 35 E
69E58EC28E6617B6E325648E74
465A4FC1C26DECC8F61B0C4DFF68D7B
14 1028207024 574565 13/01/2024 35 E
68653F09D2527FD59B98648E74
465AE83B4A083ACD6A8587D27F7930A
15 1028241027 14439 13/01/2024 86 E
AA53339AA617066CCDB5648E74
8388EE15F0D18156DEBEC39E957AAF2
16 120149029 250429 14/01/2024 84 E
C6DD20542271916E51D648E74
465A4FC1C26DECFC2826C21483C571A
17 1028207024 341102 14/01/2024 35 E
7A4397458C40586E458C648E74
801A69BFBF75E94CDA233887DE7037E
18 1872230016 120254 15/01/2024 41 E
DE3C9E90AC7743B34520748E74
8388EE15F0D18A13C0FCC17FA5609A6
19 120149029 252793 17/01/2024 46 E
78D19B81A420A875984748E74
4658D717A2EF8C1EA285D6689B8D283
20 1028123025 1207 19/01/2024 17 E
33015CB3C609F8CB971C748E74
4563F69CFA8F1BA035AD7404E073C059
21 1014143027 103037 20/01/2024 56 E
760949FC2446E65D6CF748E74

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 8388EE15F0D19C9426DD9F3957A25BD
22 120149029 260833 23/01/2024 91 E
13122392A028350F3EA848E74
465C2B186238775E76C20B3617A40CC6
23 1028313028 291027 25/01/2024 53 E
06D9CBF5E72E8C81665948E74
457ACDF26B0DB317547AAF28156137F
24 1015447026 143388 27/01/2024 10 E
4C9E11539852B3F2B15D948E74
34CEBABB97C0EAD676F0E4ED8FC9824
25 771783015 556659 27/01/2024 70 E
8237E1639E15FDB48DD9948E74
457ACDF26B0DB34A22E9271B14D7A8D
26 1015447026 48633 28/01/2024 28 E
3F66E9C91A77A0F7EFF0A48E74
465C2B1862387820B776A60CE1FB4F55
27 1028313028 295178 29/01/2024 91 E
B0DA89E2491423ECC44A48E74
8388EE15F0D1B56B18424ED8F4066845
28 120149029 269593 31/01/2024 84 E
2545A45A93985586B8A48E74
465C2B18623885FF86F2FF98BFD6C298
29 1028313028 298919 01/02/2024 77 E
12F7D632678A6183980B58E74
92795A23DA3DE93054CB826B506CFD0
30 133795023 169377 02/02/2024 12 E
24C21D4AA558B0DA105B58E74
65FCD168B0C1B3CB1BC77562DB5D079
31 1490550010 486395 03/02/2024 42 E
1D8D2ABDEE5272ADBE98B58E74
457ACDF26B0DC1BAA678581F506318F
32 1015447026 83025 03/02/2024 31 E
A1EDE6A98A42B0DA7568B58E74
4563F69CFA8F2C30C4FC3D64B3B53272
33 1014143027 118559 06/02/2024 35 E
F34FCEAD664CB209953C58E74
92795A23DA3DF85B2CC7E031A98980C
34 133795023 265256 07/02/2024 126 E
A45CE909011F90B68E3C58E74
8388EE15F0D2A5970DA9E8A16C39260
35 120149029 279827 09/02/2024 49 E
C7805A1DE59D50F3A4BC58E74
465C2B18623887BAB6BF7A056BB59A8
36 1028313028 312024 10/02/2024 35 E
10F62F2D7088F7058012D58E74
92795A23DA3E04E67CCFBA15CE128BE
37 133795023 195314 11/02/2024 17 E
EDC25603428692D1FC2D58E74
457D0BEC5C2756609D1BE398EB98C2C
38 1015575027 414900 11/02/2024 35 E
0447223288892AEBC5D5D58E74
AEEFD2D66861311FF6237C04AF7A5DE
39 159794022 98823 15/02/2024 28 E
33B52BEE62112D0DBB4E58E74
801A69BFBF75FC8BD05E7A8DF12DEED
40 1872230016 152089 15/02/2024 28 E
9700E0D65A661F8AD0B4E58E74
801A69BFBF75FCBFB9B919F32196494F
41 1872230016 153489 16/02/2024 35 E
023065A0A669E188A68E58E74
92795A23DA3E172C59F8C3016C58DF4
42 133795023 268922 17/02/2024 42 E
4272C2E8439770A2929E58E74
801A69BFBF75FCED8192818D78628750
43 1872230016 154306 17/02/2024 35 E
80DD44454104495342CE58E74
457ACDF26B0DC49DABDFB75BA3C023
44 1015447026 86206 18/02/2024 32 E
9F882F606AC5600D79640F58E74
465C2B18623889748CE7554DB84CF96E
45 1028313028 321701 19/02/2024 42 E
A161A0C52474F58A793F58E74
801A69BFBF75FD836AF07F9112477AD3
46 1872230016 157796 20/02/2024 84 E
1F0C11968819A0E3157F58E74
801A69BFBF75FDB4B27FB6988825BDE
47 1872230016 159236 21/02/2024 52 E
B503DA6DA853148BEA0BF58E74
92795A23DA3E267E7AF7191A5235F1F4
48 133795023 270747 22/02/2024 9 E
5C3A3A2E610AF889CBF58E74
801A69BFBF75FDE502F7C06005BDDD5
49 1872230016 160437 22/02/2024 56 E
B0AFCCF6F253E30994CEF58E74
92795A23DA3E269589924651F027524F
50 133795023 270772 22/02/2024 131 E
1AD2DC88810AF889CBF58E74
149BF58E97B741B893B8A69C54B8BC1
51 301204024 984760 23/02/2024 120 E
1DC314D030706E1FE082068E74
457D0BEC5C2758ACCA16E1408707F71
52 1015575027 425008 23/02/2024 60 E
7CD8262BE025129074A2068E74
801A69BFBF75FF0C4A19BF75CC82EBB1
53 1872230016 166723 28/02/2024 49 E
9BDC471BE17366E8E15168E74
801A69BFBF75FF3D9742E1648F39D9E3
54 1872230016 167911 29/02/2024 56 E
828C5BDA6557BDB38D8168E74
457ACDF26B0DC6BBF3DC58B04A3CC77
55 1015447026 279061 29/02/2024 51 E
9575A81CB263D8E1FC39168E74
801A69BFBF760D1B1A691F5D9693564
56 1872230016 168949 01/03/2024 63 E
7391A8BB7273E7A9C015278E74

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 92795A23DA3F1D472210BE26B9E9F02
57 133795023 176029 02/03/2024 20 E
3543C370259353E6FC5278E74
10732EB83EC6826D351D0CC31EAA219
58 240416020 31704 03/03/2024 18 E
3855E84F7041997ED40D278E74
801A69BFBF760DB26F7C0243DE9EC41
59 1872230016 172120 04/03/2024 56 E
2736672470376294248C278E74
801A69BFBF760E14F7072072275EBF35
60 1872230016 174797 06/03/2024 35 E
93CC670E2742DB631B7378E74
801A69BFBF760E4282D74101D62D3FB
61 1872230016 175436 07/03/2024 35 E
6CE8736178400E94EA6B378E74
1813B77DDA306A72480346EF8054468
62 351886021 22551 07/03/2024 59 E
D16BD1698636195519EB378E74
45D0FBFB22D17B10B91F984F196A4723
63 1020367024 46 08/03/2024 845 E
F711A3B0DF1B766C70F378E74
465AE83B4A08605AFBDFE531FCE95815
64 1028241027 74136 08/03/2024 84 E
72A90C0F06709CF4C2C378E74
457ACDF26B0DD5F3E423832C6372FC0
65 1015447026 53849 08/03/2024 16 E
EB373B38DA2386C44D8F378E74
801A69BFBF760E7409FFBD26C7054418
66 1872230016 176446 08/03/2024 56 E
8F2F3B3AC294BC1942F378E74
45D0FBFB22D17B10C66D643E4E12738
67 1020367024 116 08/03/2024 209 E
AA44D0E808E7DFE5C70F378E74
457ACDF26B0DD62748AC7EA30A9016B
68 1015447026 90549 09/03/2024 14 E
C0509434F243482C2083478E74
801A69BFBF760F080A057AC5125D6F6E
69 1872230016 179575 11/03/2024 56 E
E2FFE1B4670512A915A478E74
465C2B1862389B2F46742B439291EEA3
70 1028313028 349008 11/03/2024 56 E
6ABE63F201812C5915A478E74
801A69BFBF760F3CF2227EC64DA2AEB
71 1872230016 181721 12/03/2024 70 E
54839AC3DA62EA974B0E478E74
457ACDF26B0DD6EBE0D1ACFD58A4D9
72 1015447026 54605 13/03/2024 20 E
CAACA2351E25475EDD662578E74
801A69BFBF760F9DE91CD57A7A90E6B
73 1872230016 183921 14/03/2024 35 E
71A94C92CA028CA2AE75578E74
92795A23DA3F4557F9E7110C3F4AD3D
74 133795023 179213 15/03/2024 11 E
FDA8BDD62605FA03D36578E74
801A69BFBF760FCD4BEE6C4D666F6FF
75 1872230016 184835 15/03/2024 63 E
590A63BD3E115EBF4839578E74
457ACDF26B0DD7B09C4EB1AD90E6156
76 1015447026 55061 17/03/2024 38 E
EC354ECEB2777A395411678E74
8388EE15F0D3F5A019AC3233E40FC239
77 120149029 388696 18/03/2024 35 E
B34330706067EEACA4678E74
801A69BFBF7610F536CF146DBB53948
78 1872230016 191707 21/03/2024 49 E
D773631AAE234D20629F678E74
801A69BFBF7611267BCE0BE70DA8A7F
79 1872230016 192887 22/03/2024 35 E
EC383D634676CFD7E743778E74
457ACDF26B0DD8A7433390F8067B7E7
80 1015447026 55723 22/03/2024 34 E
36946DF0CE67333B63D3778E74
465AE83B4A08630DC798497D480076C
81 1028241027 90050 22/03/2024 57 E
B0EC9E6E5447B24AB350778E74
801A69BFBF7611267D09533940905812
82 1872230016 192888 22/03/2024 28 E
A669D7BB076CFD7E743778E74
465C2B1862389DE1269CA6BEEDDDD3
83 1028313028 366440 25/03/2024 42 E
A003744B11004C631197E778E74
10BD5261A4AD7154E8C62CAB17AF7C6
84 3914378019 2460 25/03/2024 35 E
4729DA4629893795D27CE778E74
801A69BFBF7611EB81B30A6A0EDC010
85 1872230016 196345 26/03/2024 42 E
BD73F72B1A861ADD9E22878E74
AEEFD2D668628A03C0DD959EBE089C5
86 159794022 187304 27/03/2024 56 E
261C8F3901376A82C62878E74
1C206A3A7209ADCF89FD6F0E6AB0C91
87 411071025 30094 28/03/2024 26 E
EA79EFC4CC15F051241A878E74
801A69BFBF761254CBB46CEFA173BEA
88 1872230016 199865 28/03/2024 35 E
92D956DC9A4149E8F1A9878E74
457ACDF26B0DDA329C23CC67B26C85B
89 1015447026 56621 30/03/2024 17 E
0AE18394A293B1B25BB1978E74
CC9AC48BD1B7425D5E0EF83F9843B75
90 2990299017 3133 31/03/2024 91 E
0A20231142697ACC2125978E74

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 CANTIDAD TOTAL FACTURAS PRODUCCION NACIONAL 0

CANTIDAD TOTAL OTRAS FACTURAS 90

DETERMINACION DEL PAGO A CUENTA COD. Bolivianos

D DETERMINACION DEL PAGO A CUENTA
Monto otras facturas y facturas electrónicas
COD. Bolivianos
Cod. 26 5,150

Monto facturas producción nacional Cod. 113 0

DETERMINACION DEL PAGO A CUENTA OTROS PRODUCTOS Cod. 115 = Cod. 26 *13% 670

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. 116 670

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
EDWIN ALBERTO MELGAR SCHLINK
DIA MES AÑO

22 04 2024 FIRMA CI 4190893-BE BENI

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