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
1253546 0
12 2021
NOMBRES Y APELLIDOS: RUTH TERESA AGUILAR ROCABADO
A DOMICILIO: CONSTANTINO MORALES 275
TIPO DE DOCUMENTO DE IDENTIDAD: CI - CÉDULA DE IDENTIDAD NRO. DE DOCUMENTO: 824660 LUGAR DE EXPEDICION: COCHABAMBA

NIT DEL EMPLEADOR: 176360023

B NOMBRES Y APELLIDOS O RAZON SOCIAL DEL EMPLEADOR: GOBIERNO AUTONOMO DEPARTAMENTAL DE COCHABAMBA
DOMICILIO DEL EMPLEADOR: AVENIDA ANICETO ARCE NRO. 2876 ZONA/BARRIO: MUYURINA

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

1 3575633019 237701 277405100157723 11/08/2021 70 1C-20-73-1B-AF

2 1028627025 8950 263401100160508 13/08/2021 91 C4-B3-20-9F-6E

3 1028627025 20515 263401100160554 14/08/2021 49 8E-35-EF-41-EF

4 991856018 27541 258405100026812 15/08/2021 35 7F-98-9B-FF-61

5 1028627025 22949 263401100160452 16/08/2021 78 6C-02-4B-E1-65

6 1023213028 565037 296401100016526 16/08/2021 15 9A-7C-6B-57-FA

7 2902478011 125445 277405100160681 17/08/2021 17 88-52-C7-53-7F

8 1023213028 591650 296401100016526 17/08/2021 15 CD-A7-4C-53

9 1020269020 455970 104401100000445 17/08/2021 9 66-F1-EE-9E

10 4475226012 744 271401100520098 17/08/2021 156 08-B7-14-46-9A

11 4475226012 760 271401100520098 19/08/2021 33 16-9D-A5-1F

12 1007921022 56249 277405100167632 19/08/2021 35 6F-95-6B-1B-75

13 1028627025 23876 263401100160452 20/08/2021 101 C8-36-9E-8C-06

14 1015447026 17795 271401100518864 20/08/2021 186 E2-E0-05-92-BF

15 1028627025 21754 263401100160565 20/08/2021 316 31-C5-2C-76

16 1021327025 973 162401100021474 21/08/2021 310 BC-25-7E-E1-05

17 1007921022 59424 277405100167632 21/08/2021 18 ED-29-1E-45-AE

18 1007921022 61104 277405100167632 22/08/2021 18 75-60-C0-1B-BA

19 1007921022 60479 277405100167632 22/08/2021 35 51-5B-8F-AB-5F

20 1007921022 61958 277405100167632 23/08/2021 42 0B-99-3F-43-67

21 162644026 1357 376401100047605 24/08/2021 820 48-B8-7E-8E

22 1007921022 63364 277405100167632 24/08/2021 21 74-42-AE-EE

23 3668494016 1089 375601000142667 24/08/2021 110 42-5B-D9-9C E

24 153508024 26656 277405100172983 25/08/2021 112 6F-51-5D-2F-9A

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25 1027967025 2512 273401100382502 25/08/2021 148 58-17-CF-FA-9D

26 1028627025 12099 263401100168162 25/08/2021 60 08-B9-BF-85-A7

27 1008565022 7307 263401100163624 25/08/2021 68 96-36-5A-78-10

28 1028627025 7585 263401100167886 26/08/2021 264 C2-CC-E1-78

29 1020757027 18319 253401100009687 26/08/2021 33 87-9A-EC-E7

30 2902478011 139101 277405100160681 26/08/2021 16 E8-87-45-54-54

31 1007921022 65453 277405100167632 26/08/2021 21 BD-C4-A5-68-E5

32 2902478011 100973 277405100160675 27/08/2021 35 3A-98-19-73-35

33 1028627025 14187 263401100168143 27/08/2021 50 87-4E-30-02

34 3757984015 7015 383401100453187 28/08/2021 41 8F-E6-87-EB-81

35 3454422012 135 433101100077858 28/08/2021 650

36 1007173022 1252742 416301900196070 28/08/2021 50

37 1020703023 653129 416301000276963 29/08/2021 50

38 1007173022 669717 416301900207817 29/08/2021 50

39 2902478011 145458 277405100160681 30/08/2021 16 E6-11-17-5D

40 1007921022 72288 277405100167632 31/08/2021 21 AF-B8-AD-90-91

41 1020831023 739 375401100194370 31/08/2021 200 0B-C2-1D-A1-4A

42 1009379021 406760 416401100334738 31/08/2021 428 68-06-A5-2D-CF

43 388716020 1373 437401100499695 31/08/2021 1,910 10-3D-5B-FE-EF

44 1007921022 74626 277405100167632 01/09/2021 140 0E-CD-83-AF-61

45 4454689019 32 374101110830688 01/09/2021 400 68-06-A5-2D-CF

46 297900027 10615 384401100185197 01/09/2021 50 13-A7-FF-82-27

47 1020757027 19545 253401100009687 02/09/2021 20 4A-37-79-80-35

48 1008409027 648 463401100396880 02/09/2021 1,250 61-E9-CC-B6-1A

49 1007921022 75177 277405100167632 02/09/2021 35 0A-73-8D-D4-9B

50 1022601020 5363 375401100172721 02/09/2021 385 78-18-3C-EB-DB

51 1020757027 19546 253401100009687 02/09/2021 44 33-A4-F4-02-40

52 1007921022 77240 277405100167632 03/09/2021 17 25-91-03-86

53 3502662018 2010 271101100531013 03/09/2021 75

54 1007173022 153044 416801100352942 03/09/2021 100 7D-B5-80-CB-EE E

55 1028627025 20218 263401100168115 03/09/2021 71 AC-63-10-34-A3

56 1028627025 7790 263401100168348 03/09/2021 105 B0-A6-0A-B7-D4

57 1007921022 76909 277405100167632 03/09/2021 21 B1-6B-71-80-F0

58 3575633019 292939 277405100157723 04/09/2021 112 5F-1B-7D-62-07

59 922044014 946 117401100007246 04/09/2021 117 63-1B-D2-BC

60 1020703023 1551657 416301000276959 06/09/2021 30

61 3624285017 412 265101100503242 06/09/2021 136

62 1020255020 733479 416301000292996 06/09/2021 20

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63 1007921022 80085 277405100167632 06/09/2021 14 E4-5D-46-ED

64 1007173022 669718 416301900207817 06/09/2021 50

65 1009311029 28885 387401100145010 06/09/2021 78 90-F4-35-F3

66 2961043011 15366 271401100519043 06/09/2021 145 97-5F-56-C0

67 7890673012 176 271401100559368 07/09/2021 125 2F-A1-01-39

68 2902478011 157924 277405100160681 07/09/2021 17 34-78-29-34-EC

69 1007921022 83006 277405100167632 08/09/2021 21 EB-1E-99-5A-67

70 4454689019 33 374101110830688 09/09/2021 2,700

71 2902478011 115034 277405100160675 09/09/2021 35 0D-33-6A-8F-9F

72 972871011 2324 265401100528736 10/09/2021 49 25-B3-A7-B7

73 1023201022 11650 206401100015998 11/09/2021 126 3A-F2-87-A9-46

74 298418024 13717 108401100045636 11/09/2021 55 03-7E-F6-F9-29

75 2902477018 69992 277405100167303 11/09/2021 17 6F-A0-9E-E7-1F

76 1009445021 18112 263401100172246 11/09/2021 11 7E-1D-41-2D-1E

77 1007921022 90070 277405100167632 13/09/2021 21 B1-65-B3-AC

78 1007943025 2048 434401100068648 15/09/2021 10,000 C0-CF-67-F3-46

79 1020757027 27336 253401100009673 15/09/2021 53 DD-DF-58-04

80 1023213028 1216468 296401100016526 15/09/2021 16 F7-39-0C-E7-A3

81 2902478011 170730 277405100160681 15/09/2021 19 56-F9-BD-92-F5

82 2902478011 122111 277405100160675 15/09/2021 35 4C-FC-24-0C-49

83 1007921022 93336 277405100167632 15/09/2021 151 69-C0-14-CD

84 833829012 196546 277405100156758 15/09/2021 116 57-A3-06-F0-80

85 1020269020 655205 104401100000445 17/09/2021 9 2E-BC-33-E6-1C

86 1023213028 1303203 296401100016526 17/09/2021 15 F6-B1-CC-C7-94

87 1023213028 1303324 296401100016526 17/09/2021 41 4F-50-74-BE-AC

88 1020757027 5006 265401100513743 17/09/2021 181 03-29-A4-CF

89 9431930015 18879 383401100479107 19/09/2021 44 31-E1-D1-C1

90 3722809017 1647 271101100538775 21/09/2021 53

91 2902478011 179495 277405100160681 21/09/2021 17 60-3B-6C-0E-6D

92 1015447026 56416 271401100512272 22/09/2021 263 95-62-FD-AE

93 1008397021 3831 375401100184996 22/09/2021 300 79-76-72-58

94 1022601020 345 375401100198935 22/09/2021 2,420 5C-8F-13-A7

95 1022115023 5988 376401100046765 22/09/2021 365 2D-0F-72-BF

96 1009311029 36450 387401100145010 22/09/2021 78 B4-47-70-2C

97 1020831023 1339 375401100194370 22/09/2021 580 F9-C6-B7-6C-AE

98 3028325019 3736 274101100693601 22/09/2021 80

99 1007921022 103679 277405100167632 23/09/2021 21 65-47-00-1D-2C

100 1020757027 23415 253401100009687 23/09/2021 58 F9-22-48-E9-CF

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101 1020255020 16217370 416301000243482 24/09/2021 10

102 259726028 47904 271401100521475 24/09/2021 100 36-C3-0A-B1-21

103 1020255020 553733 416301000243482 24/09/2021 10

104 1020255020 10626860 416301000243482 24/09/2021 10

105 298418024 15245 108401100045636 25/09/2021 9 B5-1F-2C-0F

106 1007921022 106566 277405100167632 25/09/2021 21 76-89-F3-45-00

107 1023201022 13987 206401100015998 25/09/2021 116 22-E9-DB-B2

108 2902478011 186880 277405100160681 25/09/2021 17 84-BF-21-97-27

109 5917717013 2557 383101100452444 26/09/2021 300

110 5254586010 1245 384101100196759 26/09/2021 154

111 1007173022 3577341 416301900218677 26/09/2021 10

112 1028627025 22809 263401100160512 26/09/2021 40 7C-54-4D-D8-8F

113 1007173022 3267405 416301000248556 26/09/2021 10

114 246828025 13113 271401100553059 27/09/2021 160 BF-88-54-54-DB

115 3028325019 3775 274101100746877 27/09/2021 200 79-EF-1B-16-0C

116 1007921022 109216 277405100167632 27/09/2021 21 E4-51-B2-4A-54

117 1007173022 3226395 416301000248556 27/09/2021 10

118 1009311029 11013 387401100151254 27/09/2021 26 79-EF-1B-16-0C

119 1007173022 3631933 416301000248556 27/09/2021 10

120 1007921022 111459 277405100167632 28/09/2021 28 FA-19-17-64-E6

121 1009379021 604239 416401100334738 30/09/2021 428 55-63-A7-10

122 1007173022 31103 416801100359298 30/09/2021 100 C2-F6-B4-90-20 E

123 1009445021 17582 263401100172383 01/10/2021 347 7A-C5-59-7E-AE

124 1007921022 114643 277405100167632 01/10/2021 35 F7-B2-A3-A6

125 3575633019 353601 277405100157723 01/10/2021 112 63-A7-11-4A-9C

126 191466024 3380 256401100190604 02/10/2021 170 6A-C2-6B-FD-A7

127 1007921022 118005 277405100167632 03/10/2021 35 34-CB-09-0F-EC

128 2902478011 144483 277405100160675 05/10/2021 21 0C-81-79-95-18

129 2635185013 66753 277401100166967 07/10/2021 19 67-6B-4F-1F-8E

130 375503026 5471 383401100450025 07/10/2021 30 20-5F-5A-0E-6A

131 1009445021 18980 263401100172417 08/10/2021 437 BA-19-94-63-5B

132 1009397029 5879 263401100181646 08/10/2021 17 10-E3-29-E7-80

133 356272025 18824 387401100137659 08/10/2021 82 66-62-3F-30

134 938608015 1055 384101100203905 08/10/2021 120

135 356272025 18825 387401100137659 08/10/2021 33 02-D8-11-67-C2

136 2902478011 147927 277405100160675 08/10/2021 21 04-69-00-EE

137 4539716011 7629 277405100179134 09/10/2021 91 94-00-0F-5A-00

138 1007921022 127473 277405100167632 10/10/2021 21 71-D5-C3-C2-E3

Página 4 de 6
139 7612078018 1736 271101100560125 11/10/2021 30

140 340600027 4011 263401100167510 12/10/2021 74 6E-94-41-73

141 1020757027 33740 253401100009673 12/10/2021 19 32-AB-24-2B-3A

142 1020269020 851236 104401100000445 13/10/2021 9 AB-58-8D-BA

143 3575633019 15547 277405100179553 13/10/2021 108 3A-B1-32-FF-A2

144 1007921022 132883 277405100167632 14/10/2021 35 E7-D8-1F-29-D8

145 1007921022 132154 277405100167632 14/10/2021 21 E8-C7-94-D9-54

146 1023213028 1905034 296401100016526 15/10/2021 18 71-2D-8A-65-CA

147 1023213028 1914039 296401100016526 15/10/2021 15 D4-D0-1E-DB-F7

148 2902478011 155714 277405100160675 15/10/2021 21 AF-54-83-E6-6F

149 1007921022 135444 277405100167632 16/10/2021 21 09-5A-1F-26-25

150 2902478011 157670 277405100160675 16/10/2021 16 FE-BA-E7-83

151 4388432012 1014 386101100048706 16/10/2021 50

152 7865297018 1801 383101100500765 17/10/2021 120

153 3561780010 5764 383101100498824 17/10/2021 70

154 1007921022 137941 277405100167632 18/10/2021 21 B8-6C-60-03

155 1007921022 140866 277405100167632 20/10/2021 15 F1-FE-43-25-79

156 823940014 4039 271101100572844 20/10/2021 205

157 1007921022 140566 277405100167632 20/10/2021 21 96-15-26-39

158 298418024 8079 108401100046619 21/10/2021 48 68-1E-A0-01-B2

159 1007921022 143394 277405100167632 22/10/2021 21 0F-1E-5C-3E-F9

160 303556023 97562 252405100056336 23/10/2021 15 56-B7-EC-9F

161 1009445021 10450 263401100172233 23/10/2021 77 A4-89-18-2B-BC

162 1009445021 2751 263401100172320 23/10/2021 14 08-4A-29-55

163 1007921022 147400 277405100167632 25/10/2021 35 28-F9-6E-AF

164 1020757027 1569 253401100012950 25/10/2021 44 65-72-B6-A5-40

165 2902478011 234455 277405100160681 26/10/2021 17 F9-2F-5C-AD-BA

166 2902478011 240860 277405100160681 29/10/2021 17 77-10-85-4D-FB

167 393968024 740 272101160458144 30/10/2021 60

CANTIDAD TOTAL FACTURAS PRODUCCION NACIONAL 0

CANTIDAD TOTAL OTRAS FACTURAS 167

DETERMINACION DEL PAGO A CUENTA COD. Bolivianos

D DETERMINACION DEL PAGO A CUENTA
Monto otras facturas y facturas electrónicas
COD. Bolivianos
Cod. 26 32,928

Monto facturas producción nacional Cod. 113 0

DETERMINACION DEL PAGO A CUENTA OTROS PRODUCTOS Cod. 115 = Cod. 26 *13% 4,281

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 4,281

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

Página 5 de 6
 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

LUGAR ACLARACION DE FIRMA FIRMA Y SELLO EMPLEADOR
FORMULARIO
COCHABAMBA
RUTH TERESA AGUILAR ROCABADO
DIA MES AÑO

01 12 2021 FIRMA CI 824660 COCHABAMBA

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