0002019243-24-000001.txt : 20240417 0002019243-24-000001.hdr.sgml : 20240417 20240417165918 ACCESSION NUMBER: 0002019243-24-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20240417 DATE AS OF CHANGE: 20240417 EFFECTIVENESS DATE: 20240417 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provenance Chain Network, Inc. CENTRAL INDEX KEY: 0002019243 ORGANIZATION NAME: IRS NUMBER: 842454114 STATE OF INCORPORATION: OR FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-510895 FILM NUMBER: 24851813 BUSINESS ADDRESS: STREET 1: 14945 SW SEQUOIA PKWAY STREET 2: SUITE 150 OFFICE 109 CITY: PORTLAND STATE: OR ZIP: 97224 BUSINESS PHONE: 5037044211 MAIL ADDRESS: STREET 1: 14945 SW SEQUOIA PKWAY STREET 2: SUITE 150 OFFICE 109 CITY: PORTLAND STATE: OR ZIP: 97224 D 1 primary_doc.xml X0708 D LIVE 0002019243 Provenance Chain Network, Inc. 14945 SW SEQUOIA PKWAY SUITE 150 OFFICE 109 PORTLAND OR OREGON 97224 5037044211 OREGON None None Corporation true 2019 Jeffrey Gaus 14945 SW Sequoia Pkway Suite 150 Office 109 Portland OR OREGON 97224 Executive Officer Director Robert A. Funk, Jr. 14945 SW Sequoia Pkway Suite 150 Office 109 Portland OR OREGON 97224 Director Matthew Wand 14945 SW Sequoia Pkway Suite 150 Office 109 Portland OR OREGON 97224 Director Other Technology Decline to Disclose 06b false 2024-04-02 false true false 0 8000000 4000000 4000000 false 1 0 0 0 false Provenance Chain Network, Inc. /s/ Jeffrey Gaus Jeffrey Gaus Chief Executive Officer 2024-04-15