0001896852-21-000003.txt : 20211202 0001896852-21-000003.hdr.sgml : 20211202 20211202165311 ACCESSION NUMBER: 0001896852-21-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211202 DATE AS OF CHANGE: 20211202 EFFECTIVENESS DATE: 20211202 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Proto Lase, Inc. CENTRAL INDEX KEY: 0001896852 IRS NUMBER: 824077489 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-423429 FILM NUMBER: 211467449 BUSINESS ADDRESS: STREET 1: 11600 96TH AVENUE NORTH CITY: MAPLE GROVE STATE: MN ZIP: 55369 BUSINESS PHONE: (320) 224-6317 MAIL ADDRESS: STREET 1: 11600 96TH AVENUE NORTH CITY: MAPLE GROVE STATE: MN ZIP: 55369 D 1 primary_doc.xml X0708 D LIVE 0001896852 Proto Lase, Inc. 11600 96TH AVENUE NORTH MAPLE GROVE MN MINNESOTA 55369 (320) 224-6317 DELAWARE None None Corporation true 2021 DARYL KIEFER 11600 96TH AVENUE NORTH MAPLE GROVE MN MINNESOTA 55369 Executive Officer Director Director and Chief Executive Officer of Issuer BRADY HATCHER 11600 96TH AVENUE NORTH MAPLE GROVE MN MINNESOTA 55369 Executive Officer Director Director and Chief Operating Officer of Issuer YUAN WEI TAI 46540 FREMONT BLVD. SUITE 514 FREMONT CA CALIFORNIA 94538 Director Director of Issuer DARLENE KIEFER 11600 96TH AVENUE NORTH MAPLE GROVE MN MINNESOTA 55369 Executive Officer Chief Financial Officer of Issuer Manufacturing Decline to Disclose 06b false 2021-11-19 false true false 0 3333333 3333333 0 false 1 0 0 0 false Proto Lase, Inc. /s/ Darlene Kiefer Darlene Kiefer Chief Financial Officer 2021-12-02