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[]
["PODER JUDICIAL"]
["San José, Costa Rica"]
[]
["FORMULARIO DE LIQUIDACION DE GASTOS DE VIAJE Y DE TRANSPORTE EN EL EXTERIOR"]
[]
["N°           "]
[]
["Nombre del Funcionario:",null,null,null,"Fecha de liquidación: "]
[]
["Cédula de identidad:",null,null,null,"Departamento o Sección: "]
["Nº "]
["Cargo que desempeña: ",null,null,null,"Suma adelantada: "]
[{"$nulls":4},"¢"]
["Acuerdo del Órgano Superior: ",null,null,null,"Fecha: "]
["Órgano:                              Sesión:",null,null,"Artículo: ","   __ / ___ / ___"]
["SALIDA DE COSTA RICA",null,"__ / __ / __            __ : __  hrs.",null,"REGRESO A COSTA RICA     ",null,"__ / __ / __            __ : __  hrs."]
["PAÍS\nVISITADO ","LLEGADA","SALIDA","Nº\nDIAS ","%","TARIFA\nDIARIA","TOTAL"]
[null,"FECHA: \n__ / __ / __","FECHA: \n__ / __ / __",0,0,0,0]
[null,"HORA: \n__ : __ hrs.","HORA: \n__ : __ hrs.","__ / __ / __"]
[null,"FECHA: \n__ / __ / __","FECHA: \n__ / __ / __",0,0,0,0]
[null,"HORA: \n__ : __ hrs.","HORA: \n__ : __ hrs.","__ / __ / __"]
[null,"FECHA: \n__ / __ / __","FECHA: \n__ / __ / __",0,0,0,0]
[null,"HORA: \n__ : __ hrs.","HORA: \n__ : __ hrs.","__ / __ / __"]
[null,null,0.6777777777777778,null,null,null,0]
["OTROS GASTOS"]
[" TOTAL EN $",{"$nulls":5},0]
["Cálculo:",0,"al tipo de cambio del","__ / __ / __ ....","¢","TOTAL EN ¢",0]
["Valor en letras: ","  ______________________________________ colones con 00/100."]
["Diferencia:",null,0]
["Motivo del viaje: "]
["Observaciones:"]
["Declaro bajo juramento que lo arriba expuesto es una relación correcta de los gastos incurridos en asuntos oficiales.",null,null,null,"Autorizado por"]
[{"$nulls":4},"Nombre: ","_____________________________"]
[{"$nulls":4},"Cargo que ocupa:","_____________________________"]
["Firma del funcionario: _____________________________",null,null,null,"Firma: _____________________________ Sello de Oficina:"]
[]
["Revisado por Coordinador de Área Pagos Menores",null,null,null,"Vº Bº Jefe Departamento Financiero Contable"]
[]
[]
[]
["_____________________________________",null,null,null,"_____________________________________"]
["Lic.                                                   ",null,null,null,"Lic.                                              "]
["Departamento Financiero Contable",null,null,null,"Departamento Financiero Contable"]